Active NPI
Jaclyn Michelle Scroggins, D.M.D., M.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Kirkwood, MO
National Provider Identifier
1083842660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 2012041113
- Practice address
- 209 S Kirkwood Rd
Kirkwood, MO 63122-4305 - Phone
- (314) 821-1101
- NPI assigned
- Jun 23, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.028002 | IL | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2012041113 | MO | Primary |
Addresses
Primary practice location
209 S Kirkwood Rd
Kirkwood, MO 63122-4305
Mailing address
12246 Bent Springs Dr
Saint Louis, MO 63122-2117
Phone (630) 707-1484
Other names 1
- Dr. Jaclyn Michelle Ackman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.028002 | IL | MD | Dentist |
| 2012041113 | MO | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jaclyn M. Scroggins, DMD, Ms, LLC | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Kirkwood, MO
- NPI 1184039323
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489536000000",
"number": "1083842660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12246 BENT SPRINGS DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631222117",
"telephone_number": "630-707-1484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 S KIRKWOOD RD",
"city": "KIRKWOOD",
"state": "MO",
"postal_code": "631224305",
"telephone_number": "314-821-1101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCROGGINS",
"first_name": "JACLYN",
"middle_name": "MICHELLE",
"name_prefix": "Dr.",
"credential": "D.M.D., M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-23",
"last_updated": "2017-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.028002",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MO",
"license": "2012041113",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACLYN",
"last_name": "ACKMAN",
"middle_name": "MICHELLE",
"prefix": "DR.",
"credential": "D.M.D.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Kirkwood, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.