Provider Demographics
NPI:1033802228
Name:SCRUGGS, ZACHARIAH (DDS)
Entity Type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 PASCAL ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2337
Mailing Address - Country:US
Mailing Address - Phone:507-244-0713
Mailing Address - Fax:
Practice Address - Street 1:2830 DARLING CT
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-2754
Practice Address - Country:US
Practice Address - Phone:608-783-7330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001163-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice