Provider Demographics
NPI:1861441289
Name:ROGERS, CLARK W (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:W
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 1:318 HANNES ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1770
Mailing Address - Country:US
Mailing Address - Phone:301-593-3254
Mailing Address - Fax:
Practice Address - Street 1:108 ELDEN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4828
Practice Address - Country:US
Practice Address - Phone:703-471-7164
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist