Healthcare Provider Details

I. General information

NPI: 1881601573
Provider Name (Legal Business Name): STANLEY GRAY ROGERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E WILLIAMS ST STE D
APEX NC
27502
US

IV. Provider business mailing address

412 E WILLIAMS ST STE D
APEX NC
27502
US

V. Phone/Fax

Practice location:
  • Phone: 919-362-5777
  • Fax: 919-367-8561
Mailing address:
  • Phone: 919-362-5777
  • Fax: 919-367-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4015
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: