Provider Demographics
NPI:1306034046
Name:ROGERS, DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:ROGERS
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 1:46900 MONROE ST
Mailing Address - Street 2:STE. B201
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4827
Mailing Address - Country:US
Mailing Address - Phone:760-396-5733
Mailing Address - Fax:760-396-5723
Practice Address - Street 1:46900 MONROE ST
Practice Address - Street 2:STE. B201
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4827
Practice Address - Country:US
Practice Address - Phone:760-396-5733
Practice Address - Fax:760-396-5723
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD46425OtherMEDI-CAL