Provider Demographics
NPI:1871192625
Name:ROGERS, SPENCER LYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:LYN
Last Name:ROGERS
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 1:4643 LOMA DEL REY CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-4110
Mailing Address - Country:US
Mailing Address - Phone:469-396-3063
Mailing Address - Fax:
Practice Address - Street 1:11334 SSG SIMS ST
Practice Address - Street 2:
Practice Address - City:FORT BLISS
Practice Address - State:AP
Practice Address - Zip Code:79908
Practice Address - Country:US
Practice Address - Phone:469-396-3063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist