Provider Demographics
NPI:1023206844
Name:ROGERS, MICHAEL B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 31ST ST S
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206
Mailing Address - Country:US
Mailing Address - Phone:703-671-1001
Mailing Address - Fax:703-820-4921
Practice Address - Street 1:4850 31ST ST S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206
Practice Address - Country:US
Practice Address - Phone:703-671-1001
Practice Address - Fax:703-820-4921
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA75901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice