Provider Demographics
NPI:1568680825
Name:ROGERS, JOHN A (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E MCANDREWS RD STE B
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5300
Mailing Address - Country:US
Mailing Address - Phone:541-772-0109
Mailing Address - Fax:541-770-2864
Practice Address - Street 1:1601 E MCANDREWS RD STE B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-5300
Practice Address - Country:US
Practice Address - Phone:541-772-0109
Practice Address - Fax:541-770-2864
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD5094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist