Provider Demographics
NPI:1184798100
Name:ELLIS I ROGERS, D.D.S.
Entity type:Organization
Organization Name:ELLIS I ROGERS, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-963-5821
Mailing Address - Street 1:312 N ALMA SCHOOL RD
Mailing Address - Street 2:STE. 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4354
Mailing Address - Country:US
Mailing Address - Phone:480-963-5821
Mailing Address - Fax:480-963-8239
Practice Address - Street 1:312 N ALMA SCHOOL RD
Practice Address - Street 2:STE. 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4354
Practice Address - Country:US
Practice Address - Phone:480-963-5821
Practice Address - Fax:480-963-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
339776OtherUNITED CONCORDIA
=========OtherAETNA
=========OtherBCBS-DENT MAX
=========OtherGUARDIAN
339776OtherUNITED CONCORDIA
=========OtherHUMANA
=========OtherDELTA DENTAL
=========OtherPRINCIPAL
=========OtherJEFFERSON PILOT
=========OtherU.F.W.A.
=========OtherMETLIFE
=========OtherSOUTHWEST TEAMSTERS