Healthcare Provider Details

I. General information

NPI: 1497883656
Provider Name (Legal Business Name): JAMES K. ROGERS, D.D.S., M.S., L.T.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 S. TOWN CENTER DR. SUITE 110
LAS VEGAS NV
89135
US

IV. Provider business mailing address

3575 S. TOWN CENTER DR. SUITE 110
LAS VEGAS NV
89135
US

V. Phone/Fax

Practice location:
  • Phone: 702-966-0300
  • Fax:
Mailing address:
  • Phone: 702-966-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3081 S4-22
License Number StateNV

VIII. Authorized Official

Name: DR. JAMES ROGERS
Title or Position: PRESIDENT
Credential: D.D.S., M.S.
Phone: 702-966-0300