Provider Demographics
NPI:1205839511
Name:SCOGGINS, JOHN E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:SCOGGINS
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 1:1252 AIRPORT PARK BLVD
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5979
Mailing Address - Country:US
Mailing Address - Phone:707-462-8719
Mailing Address - Fax:707-463-8632
Practice Address - Street 1:1252 AIRPORT PARK BLVD
Practice Address - Street 2:SUITE D-1
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5979
Practice Address - Country:US
Practice Address - Phone:707-462-8719
Practice Address - Fax:707-463-8632
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice