Provider Demographics
NPI:1811209026
Name:SCRUGGS, WILLIAM PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:PATRICK
Other - Last Name:SCRUGGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2945 NEW BERN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1213
Mailing Address - Country:US
Mailing Address - Phone:191-962-3029
Mailing Address - Fax:191-983-4733
Practice Address - Street 1:2945 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1213
Practice Address - Country:US
Practice Address - Phone:191-962-3029
Practice Address - Fax:191-983-4733
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist