Healthcare Provider Details

I. General information

NPI: 1770071946
Provider Name (Legal Business Name): BRYAN ROGERS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 SISKIYOU BLVD
ASHLAND OR
97520-2470
US

IV. Provider business mailing address

1661 SISKIYOU BLVD
ASHLAND OR
97520-2470
US

V. Phone/Fax

Practice location:
  • Phone: 458-246-1247
  • Fax:
Mailing address:
  • Phone: 458-246-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD10961
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD226379
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: