Healthcare Provider Details

I. General information

NPI: 1184601601
Provider Name (Legal Business Name): W CURTIS ROGERS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 SOUTH ALLISON AVE
GREENFIELD MO
65661
US

IV. Provider business mailing address

P O BOX 68 162 SOUTH ALLISON AVE
GREENFIELD MO
65661-0068
US

V. Phone/Fax

Practice location:
  • Phone: 417-637-5933
  • Fax: 417-637-5935
Mailing address:
  • Phone: 417-637-5933
  • Fax: 417-637-5935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13714
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: