Healthcare Provider Details

I. General information

NPI: 1881140473
Provider Name (Legal Business Name): LEAH ROGOWSKI D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2963 W ELLIOT RD STE 1
CHANDLER AZ
85224-1633
US

IV. Provider business mailing address

608 S RIATA ST
GILBERT AZ
85296-2928
US

V. Phone/Fax

Practice location:
  • Phone: 480-220-3894
  • Fax:
Mailing address:
  • Phone: 480-220-3894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN 22123
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD011241
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: