Provider Demographics
NPI:1558581124
Name:ROGERS, BRUCE MCCLELLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MCCLELLAN
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 1:19621 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3528
Mailing Address - Country:US
Mailing Address - Phone:714-970-6331
Mailing Address - Fax:714-970-6345
Practice Address - Street 1:19621 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3528
Practice Address - Country:US
Practice Address - Phone:714-970-6331
Practice Address - Fax:714-970-6345
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist