Provider Demographics
NPI:1033831821
Name:ROGERS, KRISTEN (DDS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 NORTHGATE CIR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3037
Mailing Address - Country:US
Mailing Address - Phone:516-312-6411
Mailing Address - Fax:
Practice Address - Street 1:1075 CENTRAL PARK AVE STE 207
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3250
Practice Address - Country:US
Practice Address - Phone:914-472-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24394122300000X
FL24394122300000X
NY062800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY062800OtherLICENSE
FL24394OtherLICENSE