Provider Demographics
NPI:1659945764
Name:SCRUGGS, RAE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAE
Middle Name:ANNE
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 E 70TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5393
Mailing Address - Country:US
Mailing Address - Phone:318-402-9220
Mailing Address - Fax:
Practice Address - Street 1:2001 E 70TH ST STE 105
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5393
Practice Address - Country:US
Practice Address - Phone:318-402-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist