Provider Demographics
NPI:1255690939
Name:ROGERS, LINDSAY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:MARIE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 S GRANT ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8341
Mailing Address - Country:US
Mailing Address - Phone:406-543-7532
Mailing Address - Fax:
Practice Address - Street 1:3111 S GRANT ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8341
Practice Address - Country:US
Practice Address - Phone:406-543-7532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21411223G0001X
MT9485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice