Provider Demographics
NPI:1932279833
Name:ROGERS, JOEY E (DMD,PA)
Entity Type:Individual
Prefix:DR
First Name:JOEY
Middle Name:E
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DMD,PA
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 1718
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-1718
Mailing Address - Country:US
Mailing Address - Phone:601-765-8881
Mailing Address - Fax:601-765-0309
Practice Address - Street 1:201 ARRINGTON AVE.
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428
Practice Address - Country:US
Practice Address - Phone:601-765-8881
Practice Address - Fax:601-765-0309
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2959-961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice