Provider Demographics
NPI:1568585479
Name:ROGERS, GREGG T (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:T
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 1:1440 28TH ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1030
Mailing Address - Country:US
Mailing Address - Phone:303-447-0460
Mailing Address - Fax:303-447-9578
Practice Address - Street 1:1440 28TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1030
Practice Address - Country:US
Practice Address - Phone:303-447-0460
Practice Address - Fax:303-447-9578
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO1048971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics