Provider Demographics
NPI:1487650511
Name:ROGERS, PAUL NICHOLAS (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:NICHOLAS
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1939 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-1724
Mailing Address - Country:US
Mailing Address - Phone:620-442-5660
Mailing Address - Fax:620-442-5682
Practice Address - Street 1:1939 N 11TH ST
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-1724
Practice Address - Country:US
Practice Address - Phone:620-442-5660
Practice Address - Fax:620-442-5682
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS55111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100221560AMedicaid
KS008982OtherBLUE CROSS BLUE SHIELD
KY480951021OtherDELTA DENTAL