Provider Demographics
NPI:1932119914
Name:SCRUGGS, JEFFREY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:SCRUGGS
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 1:2001 E 70TH STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5393
Mailing Address - Country:US
Mailing Address - Phone:318-798-2008
Mailing Address - Fax:318-798-9421
Practice Address - Street 1:2001 E 70TH STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5393
Practice Address - Country:US
Practice Address - Phone:318-798-2008
Practice Address - Fax:318-798-9421
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice