Provider Demographics
NPI:1609980036
Name:ROGERS, JASON SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:SCOTT
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 1:810 E MAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-3547
Mailing Address - Country:US
Mailing Address - Phone:864-200-1999
Mailing Address - Fax:
Practice Address - Street 1:810 E MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-3535
Practice Address - Country:US
Practice Address - Phone:864-715-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist