Healthcare Provider Details

I. General information

NPI: 1952304495
Provider Name (Legal Business Name): SCOTT W ROGERS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2005
Last Update Date: 11/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 WASHINGTON AVE
PLEASANTVILLE NY
10570-2854
US

IV. Provider business mailing address

106 WASHINGTON AVE
PLEASANTVILLE NY
10570-2854
US

V. Phone/Fax

Practice location:
  • Phone: 914-747-0907
  • Fax: 914-747-0989
Mailing address:
  • Phone: 914-747-0907
  • Fax: 914-747-0989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number036087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: