Provider Demographics
NPI:1497866222
Name:ROGERS, KENNETH SANDLIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:SANDLIN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2559
Mailing Address - Country:US
Mailing Address - Phone:205-631-3743
Mailing Address - Fax:205-631-6930
Practice Address - Street 1:1021 FULTON AVE
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2559
Practice Address - Country:US
Practice Address - Phone:205-631-3743
Practice Address - Fax:205-631-6930
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice