Provider Demographics
NPI:1710301528
Name:ROGERS, MARCY ALLISON WELLS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:ALLISON WELLS
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:ALLISON
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4745 S 3200 W
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2822
Mailing Address - Country:US
Mailing Address - Phone:801-858-3461
Mailing Address - Fax:801-955-2389
Practice Address - Street 1:1388 S NAVAJO ST
Practice Address - Street 2:SUITE C
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-3493
Practice Address - Country:US
Practice Address - Phone:801-955-2360
Practice Address - Fax:801-982-9232
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8892642-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No122300000XDental ProvidersDentist