Provider Demographics
NPI:1508034273
Name:RODGERS, ROSEANNE C (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSEANNE
Middle Name:C
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 1:197 BERKSHIRE LOOP
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6337
Mailing Address - Country:US
Mailing Address - Phone:443-796-5982
Mailing Address - Fax:
Practice Address - Street 1:1209 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2853
Practice Address - Country:US
Practice Address - Phone:843-546-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93431223G0001X, 1223G0001X
GADNF0004551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice