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General NPI Number Information
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NPI Number | 1508114323
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Entity Type | Individual
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Provider Name | SHAKASHA L. SCRUGGS-WILLIAMS DDS
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Gender | Female
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 07/26/2024
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Provider Practice Location Address
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Address Line | USA DENTAC FORT CAVAZOS 36000 SHOEMAKER LN SUITE 1051 RM 1048
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City | FORT CAVAZOS
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State | TX
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Zip | 76544-5054
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Country | US
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Telephone | 254-287-2705
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Fax |
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Provider Business Mailing Address
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Address Line | USA DENTAC FORT CAVAZOS 36000 SHOEMAKER LN SUITE 1051 RM 1048
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City | FORT CAVAZOS
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State | TX
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Zip | 76544-5054
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Country | US
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Telephone | 254-287-2705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28258
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10057
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 10096
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 28258
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License Number State | TX
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