Healthcare Provider Details

I. General information

NPI: 1609679125
Provider Name (Legal Business Name): NICHOLAS JUDE RODGERS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 BELMONT ST STE 3
WORCESTER MA
01604-1008
US

IV. Provider business mailing address

131 MAIN STREET
SOUTH LANCASTER MA
01561
US

V. Phone/Fax

Practice location:
  • Phone: 774-420-7020
  • Fax:
Mailing address:
  • Phone: 978-365-5643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10001458
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: