Provider Demographics
NPI:1679771547
Name:SCRUGGS, CANDACE REBECCA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:REBECCA
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4000 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE B13
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066
Mailing Address - Country:US
Mailing Address - Phone:315-637-4476
Mailing Address - Fax:315-637-1261
Practice Address - Street 1:5109 W GENESEE ST STE 101
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2372
Practice Address - Country:US
Practice Address - Phone:315-487-2668
Practice Address - Fax:315-487-8661
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0555841223S0112X
SC4347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist