Provider Demographics
NPI:1033818273
Name:ROGERS, KAITLYN (RDH)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 KINGSTON PIKE STE C
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2890
Mailing Address - Country:US
Mailing Address - Phone:865-986-5310
Mailing Address - Fax:865-986-5319
Practice Address - Street 1:11121 KINGSTON PIKE STE C
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2890
Practice Address - Country:US
Practice Address - Phone:865-986-5310
Practice Address - Fax:865-986-5319
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9776124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist