Provider Demographics
NPI:1053325340
Name:ROGGE, ROD MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROD
Middle Name:MICHAEL
Last Name:ROGGE
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 1:762 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE #500
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6200
Mailing Address - Country:US
Mailing Address - Phone:757-333-7444
Mailing Address - Fax:757-962-9470
Practice Address - Street 1:762 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE #500
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6200
Practice Address - Country:US
Practice Address - Phone:757-333-7444
Practice Address - Fax:757-962-9470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010081851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics