Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5054 | NC |
NPI | 1043499213 |
---|---|
Provider Name | Dr. Paul E. Scruggs |
First Address | Raleigh, NC 27613-1620 |
Second Address | Raleigh, NC 27613-1620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 24/10/2007 |