Provider Demographics
NPI:1700011806
Name:ROGOFF, JOSH IDEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSH
Middle Name:IDEN
Last Name:ROGOFF
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 1:400 BOTULPH LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6911
Mailing Address - Country:US
Mailing Address - Phone:505-988-3500
Mailing Address - Fax:505-983-0513
Practice Address - Street 1:400 BOTULPH LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6911
Practice Address - Country:US
Practice Address - Phone:505-988-3500
Practice Address - Fax:505-983-0513
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD40021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice