Provider Demographics
NPI:1134726896
Name:ROGGE, BRADLEY (DDS)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:ROGGE
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 1:77 SAULSBURY RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3444
Mailing Address - Country:US
Mailing Address - Phone:302-678-2942
Mailing Address - Fax:302-678-2294
Practice Address - Street 1:77 SAULSBURY RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3444
Practice Address - Country:US
Practice Address - Phone:302-678-2942
Practice Address - Fax:302-678-2294
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00114721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice