Provider Demographics
NPI:1184039323
Name:JACLYN M. SCROGGINS, DMD, MS, LLC
Entity Type:Organization
Organization Name:JACLYN M. SCROGGINS, DMD, MS, LLC
Other - Org Name:JUNCTION ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SCROGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:314-821-1101
Mailing Address - Street 1:209 S KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4305
Mailing Address - Country:US
Mailing Address - Phone:314-821-1101
Mailing Address - Fax:314-821-3631
Practice Address - Street 1:209 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4305
Practice Address - Country:US
Practice Address - Phone:314-821-1101
Practice Address - Fax:314-821-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120411131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty