Healthcare Provider Details

I. General information

NPI: 1861543480
Provider Name (Legal Business Name): RAYMOND LEWIS ROGERS JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GATLIN AVE
ORLANDO FL
32806-6951
US

IV. Provider business mailing address

300 GATLIN AVE
ORLANDO FL
32806-6951
US

V. Phone/Fax

Practice location:
  • Phone: 407-857-4244
  • Fax: 407-857-2204
Mailing address:
  • Phone: 407-857-4244
  • Fax: 407-857-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN7404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: