Healthcare Provider Details

I. General information

NPI: 1497131510
Provider Name (Legal Business Name): CHRISTOPHER ROGOWSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 F AVE
DOUGLAS AZ
85607-1919
US

IV. Provider business mailing address

155 CALLE PORTAL STE. 100
SIERRA VISTA AZ
85635-2900
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-3285
  • Fax:
Mailing address:
  • Phone: 520-459-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD009498
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS040498
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: