Provider Demographics
NPI:1982656336
Name:ROGERS, HAROLD EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:EDWARD
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:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-0599
Mailing Address - Country:US
Mailing Address - Phone:919-553-3173
Mailing Address - Fax:919-553-0163
Practice Address - Street 1:319 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2465
Practice Address - Country:US
Practice Address - Phone:919-553-3173
Practice Address - Fax:919-553-0163
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC48061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899450Medicaid