Provider Demographics
NPI:1245386028
Name:ROGERS, HARDIN WINSLOW III (DDS MS PA)
Entity Type:Individual
Prefix:DR
First Name:HARDIN
Middle Name:WINSLOW
Last Name:ROGERS
Suffix:III
Gender:M
Credentials:DDS MS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PEACHTREE STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804
Mailing Address - Country:US
Mailing Address - Phone:252-446-0117
Mailing Address - Fax:252-446-2264
Practice Address - Street 1:400 PEACHTREE STREET
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804
Practice Address - Country:US
Practice Address - Phone:252-446-0117
Practice Address - Fax:252-446-2264
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6399122300000X
AL4665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC96875OtherBLUE CROSS BLUE SHIELD
NC6399OtherNC STATE LICENSE