Provider Demographics
NPI:1245433408
Name:RODGERS, ANGELIQUE L (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:L
Last Name:RODGERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 COLLINS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-1795
Mailing Address - Country:US
Mailing Address - Phone:404-394-5311
Mailing Address - Fax:
Practice Address - Street 1:876 BUFORD RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-2716
Practice Address - Country:US
Practice Address - Phone:470-990-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10008301223X0400X
GADN0108541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics