Provider Demographics
NPI:1083898191
Name:ROGERS, LLOYD MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:MICHAEL
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 HERITAGE VILLAGE PLAZA
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3091
Mailing Address - Country:US
Mailing Address - Phone:571-248-6585
Mailing Address - Fax:
Practice Address - Street 1:7450 HERITAGE VILLAGE PLAZA
Practice Address - Street 2:SUITE 102
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155
Practice Address - Country:US
Practice Address - Phone:571-248-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014110371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice