Provider Demographics
NPI:1952517047
Name:ROGERS, ANGELA MICHELLE (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MICHELLE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18181 W 12 MILE RD
Mailing Address - Street 2:SUITE1
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2666
Mailing Address - Country:US
Mailing Address - Phone:248-559-5554
Mailing Address - Fax:248-553-3114
Practice Address - Street 1:18181 W 12 MILE RD
Practice Address - Street 2:SUITE1
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2666
Practice Address - Country:US
Practice Address - Phone:248-559-5554
Practice Address - Fax:248-553-3114
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI131981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4632963Medicaid