Healthcare Provider Details

I. General information

NPI: 1205723640
Provider Name (Legal Business Name): ROGERS CENTER FOR ORAL & FACIAL SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 HOLCOMB BRIDGE RD STE 4
NORCROSS GA
30092-2212
US

IV. Provider business mailing address

3875 HOLCOMB BRIDGE RD STE 4
PEACHTREE CORNERS GA
30092-2212
US

V. Phone/Fax

Practice location:
  • Phone: 404-990-4595
  • Fax: 404-990-4597
Mailing address:
  • Phone: 404-990-4595
  • Fax: 404-990-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KAEL ROGERS
Title or Position: OWNER/SURGEON
Credential: DDS, MD
Phone: 404-990-4595