Provider Demographics
NPI:1952304495
Name:ROGERS, SCOTT W (DMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
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 1:106 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2854
Mailing Address - Country:US
Mailing Address - Phone:914-747-0907
Mailing Address - Fax:914-747-0989
Practice Address - Street 1:106 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2854
Practice Address - Country:US
Practice Address - Phone:914-747-0907
Practice Address - Fax:914-747-0989
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-28
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0360871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice