Provider Demographics
NPI:1275627051
Name:ROGERS AND REAGAN DENTAL CORPORATION
Entity Type:Organization
Organization Name:ROGERS AND REAGAN DENTAL CORPORATION
Other - Org Name:COLLEGE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-631-3060
Mailing Address - Street 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:467 COLLEGE BLVD
Practice Address - Street 2:STE. 2
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-5436
Practice Address - Country:US
Practice Address - Phone:760-631-3060
Practice Address - Fax:760-631-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty