Provider Demographics
NPI:1336620608
Name:SCRUGGS, STEVEN (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 W SADDLEHORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-5479
Mailing Address - Country:US
Mailing Address - Phone:623-703-2629
Mailing Address - Fax:
Practice Address - Street 1:821 W WICKENBURG WAY
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-4263
Practice Address - Country:US
Practice Address - Phone:928-684-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0101001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice