Provider Demographics
NPI:1982809992
Name:ROGERS, NICOLE MARIE BECK (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MARIE BECK
Last Name:ROGERS
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 1:223 W ILLINOIS ST
Mailing Address - Street 2:PO BOX 1447
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5229
Mailing Address - Country:US
Mailing Address - Phone:630-668-4500
Mailing Address - Fax:
Practice Address - Street 1:223 W ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5229
Practice Address - Country:US
Practice Address - Phone:630-668-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist