Provider Demographics
NPI:1346342334
Name:ROGERS, JAMINE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMINE
Middle Name:C
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2835
Mailing Address - Country:US
Mailing Address - Phone:256-314-0676
Mailing Address - Fax:256-314-6373
Practice Address - Street 1:301 W STATE ST
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2835
Practice Address - Country:US
Practice Address - Phone:256-314-0676
Practice Address - Fax:256-314-6373
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL92836OtherBCBS PROVIDER ID
AL19386Medicare UPIN