Provider Demographics
NPI:1669455945
Name:ROGERS, JEFFREY DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DAVID
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 1:1305 - 21ST AVENUE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701
Mailing Address - Country:US
Mailing Address - Phone:907-388-9270
Mailing Address - Fax:907-374-9696
Practice Address - Street 1:1305 - 21ST AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-388-9270
Practice Address - Fax:907-374-9696
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000098941223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics