Healthcare Provider Details

I. General information

NPI: 1083545420
Provider Name (Legal Business Name): MARILISE ROGERS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILISE STAMPS DDS

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 FAIRWAY DR
CHILLICOTHEE MO
64601-3673
US

IV. Provider business mailing address

1154 BEACON HILL LN
KANSAS CITY MO
64108-7502
US

V. Phone/Fax

Practice location:
  • Phone: 660-646-3802
  • Fax:
Mailing address:
  • Phone: 573-673-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026015073
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: