=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811209026
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM PATRICK SCRUGGS DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2010
-----------------------------------------------------
Last Update Date | 10/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2945 NEW BERN AVE
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 191-962-3029
-----------------------------------------------------
Fax | 191-983-4733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2945 NEW BERN AVE
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27610-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 191-962-3029
-----------------------------------------------------
Fax | 191-983-4733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 8950
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------