Healthcare Provider Details

I. General information

NPI: 1629235643
Provider Name (Legal Business Name): KIM AND RODGERS DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8908 MADISON AVE SUITE A
FAIR OAKS CA
95628-4010
US

IV. Provider business mailing address

2860 MICHELLE 2ND FLOOR
IRVINE CA
92606-1009
US

V. Phone/Fax

Practice location:
  • Phone: 951-536-5151
  • Fax: 916-536-5154
Mailing address:
  • Phone: 714-508-3600
  • Fax: 714-368-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES F RODGERS
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 916-536-5151