Healthcare Provider Details

I. General information

NPI: 1871578799
Provider Name (Legal Business Name): NEAL WAYNE ROGOL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 DIAMOND HILL RD
CUMBERLAND RI
02864-4703
US

IV. Provider business mailing address

2343 DIAMOND HILL RD
CUMBERLAND RI
02864-4703
US

V. Phone/Fax

Practice location:
  • Phone: 401-333-2700
  • Fax: 401-334-3369
Mailing address:
  • Phone: 401-333-2700
  • Fax: 401-334-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1998
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: