Provider Demographics
NPI:1871833947
Name:ROGERS, KRISTIN DENISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:DENISE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 S FRIENDSWOOD DR
Mailing Address - Street 2:STE A
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5410
Mailing Address - Country:US
Mailing Address - Phone:314-574-8415
Mailing Address - Fax:
Practice Address - Street 1:1780 S FRIENDSWOOD DR
Practice Address - Street 2:STE A
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5410
Practice Address - Country:US
Practice Address - Phone:314-574-8415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31907122300000X, 1223P0300X
IL019029556122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist