Provider Demographics
NPI:1225015068
Name:DROOGER, SCOTT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:DROOGER
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 1:17300 OUTER FORTY ROAD NORTH
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005
Mailing Address - Country:US
Mailing Address - Phone:636-536-5158
Mailing Address - Fax:636-536-4544
Practice Address - Street 1:17300 OUTER FORTY ROAD NORTH
Practice Address - Street 2:SUITE 103
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005
Practice Address - Country:US
Practice Address - Phone:636-536-5158
Practice Address - Fax:636-536-4544
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISD0192741223S0112X
MO20090288391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901019274OtherLICENSE NUMBER
U93994Medicare UPIN