Provider Demographics
NPI:1235581141
Name:ROGGOW, ROSS (DDS)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:ROGGOW
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 1:8243 S SICILY CT
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-7197
Mailing Address - Country:US
Mailing Address - Phone:719-393-5818
Mailing Address - Fax:
Practice Address - Street 1:810 E 88TH AVE UNIT 140
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4747
Practice Address - Country:US
Practice Address - Phone:303-653-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002029121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice