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General NPI Number Information
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NPI Number | 1639567811
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Entity Type | Organization
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Legal Business Name | KENNETH B. SCROGGINS, D.M.D., LLC
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Dates
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Enumeration Date | 12/23/2014
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 11780 MANCHESTER RD SUITE 105
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City | SAINT LOUIS
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State | MO
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Zip | 63131-4600
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Country | US
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Telephone | 314-965-3500
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Fax | 314-965-7721
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Provider Business Mailing Address
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Address Line | 11780 MANCHESTER RD SUITE 105
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City | SAINT LOUIS
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State | MO
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Zip | 63131-4600
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Country | US
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Telephone | 314-965-3500
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Fax | 314-965-7721
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH B. SCROGGINS
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Credential | D.M.D.
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Telephone | 314-965-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2011021923
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License Number State | MO
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