Provider Demographics
NPI:1083873871
Name:ROGERS, KAEL A (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:KAEL
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 PEACHTREE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2823
Mailing Address - Country:US
Mailing Address - Phone:404-990-4595
Mailing Address - Fax:
Practice Address - Street 1:5635 PEACHTREE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2823
Practice Address - Country:US
Practice Address - Phone:404-990-4595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013559122300000X, 1223S0112X
GA067081204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery