Healthcare Provider Details

I. General information

NPI: 1982809992
Provider Name (Legal Business Name): NICOLE MARIE BECK ROGERS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 W ILLINOIS ST
WHEATON IL
60187-5229
US

IV. Provider business mailing address

223 W ILLINOIS ST PO BOX 1447
WHEATON IL
60187-5229
US

V. Phone/Fax

Practice location:
  • Phone: 630-668-4500
  • Fax:
Mailing address:
  • Phone: 630-668-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019027341
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: