Healthcare Provider Details

I. General information

NPI: 1225015068
Provider Name (Legal Business Name): SCOTT A. DROOGER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 OUTER FORTY ROAD NORTH SUITE 103
CHESTERFIELD MO
63005
US

IV. Provider business mailing address

17300 OUTER FORTY ROAD NORTH SUITE 103
CHESTERFIELD MO
63005
US

V. Phone/Fax

Practice location:
  • Phone: 636-536-5158
  • Fax: 636-536-4544
Mailing address:
  • Phone: 636-536-5158
  • Fax: 636-536-4544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberSD019274
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2009028839
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: