Provider Demographics
NPI:1225298037
Name:RODGERS, SHAWN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:RODGERS
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 1:500 DALLAS ST
Mailing Address - Street 2:STE. P70
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-4800
Mailing Address - Country:US
Mailing Address - Phone:866-543-1909
Mailing Address - Fax:
Practice Address - Street 1:500 DALLAS ST
Practice Address - Street 2:STE. P70
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-4800
Practice Address - Country:US
Practice Address - Phone:866-543-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-15
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0024061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist