Provider Demographics
NPI:1477561454
Name:ROGERS, WILLIAM TODD (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TODD
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 1:5575 TECH CENTER DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919
Mailing Address - Country:US
Mailing Address - Phone:719-528-6450
Mailing Address - Fax:719-528-5834
Practice Address - Street 1:5575 TECH CENTER DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919
Practice Address - Country:US
Practice Address - Phone:719-528-6450
Practice Address - Fax:719-528-5834
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC06876122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist