Provider Demographics
NPI:1033128814
Name:ROGERS, DENNIS M (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
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 1:20429 W 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3408
Mailing Address - Country:US
Mailing Address - Phone:313-533-4333
Mailing Address - Fax:313-533-2706
Practice Address - Street 1:20429 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3408
Practice Address - Country:US
Practice Address - Phone:313-533-4333
Practice Address - Fax:313-533-2706
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI132601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1758961Medicaid