Healthcare Provider Details

I. General information

NPI: 1871439794
Provider Name (Legal Business Name): BRANDIE ROGERS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD STE 3195
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

527 N PARK AVE
INDIANAPOLIS IN
46202-3513
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-7433
  • Fax:
Mailing address:
  • Phone: 740-440-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12015058A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: