Provider Demographics
NPI:1518085919
Name:ROGERS, RICHARD STANLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STANLEY
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 1:709 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2522
Mailing Address - Country:US
Mailing Address - Phone:407-862-6090
Mailing Address - Fax:407-862-0364
Practice Address - Street 1:709 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2522
Practice Address - Country:US
Practice Address - Phone:407-862-6090
Practice Address - Fax:407-862-0364
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL116841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN11684OtherSTATE LICENSE
FLAR6585648OtherDEA NUMBER