Provider Demographics
NPI:1790852226
Name:JANES, RODGER W (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODGER
Middle Name:W
Last Name:JANES
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:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:BELLE
Mailing Address - State:MO
Mailing Address - Zip Code:65013-0759
Mailing Address - Country:US
Mailing Address - Phone:573-859-6901
Mailing Address - Fax:
Practice Address - Street 1:203 WEST THIRD ST.
Practice Address - Street 2:
Practice Address - City:BELLE
Practice Address - State:MO
Practice Address - Zip Code:65013-9998
Practice Address - Country:US
Practice Address - Phone:573-859-6901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice