MEDICARE: DR. CHARLES KEENER SCRUGGS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	13026	TX

General Provider Information

NPI Number	:	1043285109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES KEENER SCRUGGS D.D.S.

Provider Business Mailing Address
First Line	:	2501 PALMER HWY
Second Line	:	SUITE 105
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-7069
Country	:	US
Telephone Number	:	409-948-9444
Fax Number	:	409-948-9407

Provider Business Practice Location Address
First Line	:	2501 PALMER HWY
Second Line	:	SUITE 105
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-7069
Country	:	US
Telephone Number	:	409-948-9444
Fax Number	:	409-948-9407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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