Provider Demographics
NPI:1134903982
Name:SCROGGS, BENJAMIN (DMD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SCROGGS
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 1:1203 KRISTA DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8611
Mailing Address - Country:US
Mailing Address - Phone:971-712-4830
Mailing Address - Fax:
Practice Address - Street 1:104 S OLD BETSY RD
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059-2425
Practice Address - Country:US
Practice Address - Phone:817-641-2272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX399581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice