Provider Demographics
NPI:1003820598
Name:ROGOL, ALAN MARK
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MARK
Last Name:ROGOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2806
Mailing Address - Country:US
Mailing Address - Phone:508-668-1320
Mailing Address - Fax:508-668-1320
Practice Address - Street 1:230 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2806
Practice Address - Country:US
Practice Address - Phone:508-668-1320
Practice Address - Fax:508-668-1320
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice