Healthcare Provider Details

I. General information

NPI: 1740898709
Provider Name (Legal Business Name): ALEXANDRIA ROZGONY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 W RAY RD STE 8
CHANDLER AZ
85226-6224
US

IV. Provider business mailing address

4940 W RAY RD STE 8
CHANDLER AZ
85226-6224
US

V. Phone/Fax

Practice location:
  • Phone: 602-845-0989
  • Fax:
Mailing address:
  • Phone: 602-845-0989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD011936
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.032575
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: