Provider Demographics
NPI:1376606764
Name:ROGERS, ROBERT PODMORE (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PODMORE
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 1:1781 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-1338
Mailing Address - Country:US
Mailing Address - Phone:510-799-4901
Mailing Address - Fax:925-939-6100
Practice Address - Street 1:764 GRAYSON RD STE B
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2686
Practice Address - Country:US
Practice Address - Phone:925-939-6100
Practice Address - Fax:925-939-6122
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9262301OtherMEDI CAL