Provider Demographics
NPI:1033507694
Name:MICHAEL C. ROGERS, DDS, PC
Entity Type:Organization
Organization Name:MICHAEL C. ROGERS, DDS, PC
Other - Org Name:COMPLETE HEALTH DENTISTRY OF NEPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-253-5000
Mailing Address - Street 1:3373 LAKE ARIEL HWY
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1157
Mailing Address - Country:US
Mailing Address - Phone:570-253-5000
Mailing Address - Fax:570-253-8963
Practice Address - Street 1:3373 LAKE ARIEL HWY
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1157
Practice Address - Country:US
Practice Address - Phone:570-253-5000
Practice Address - Fax:570-253-8963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026802L122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty