Provider Demographics
NPI:1043285109
Name:SCRUGGS, CHARLES KEENER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KEENER
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 1:2501 PALMER HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-7069
Mailing Address - Country:US
Mailing Address - Phone:409-948-9444
Mailing Address - Fax:409-948-9407
Practice Address - Street 1:2501 PALMER HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-7069
Practice Address - Country:US
Practice Address - Phone:409-948-9444
Practice Address - Fax:409-948-9407
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15812Medicare UPIN