Healthcare Provider Details

I. General information

NPI: 1750598090
Provider Name (Legal Business Name): NANCY RODGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLD CHEROKEE RD SUITE F, BOX 14
LEXINGTON SC
29072-9316
US

IV. Provider business mailing address

904 TRAILMORE CIR
SUMTER SC
29154-6010
US

V. Phone/Fax

Practice location:
  • Phone: 803-808-2950
  • Fax: 803-808-5642
Mailing address:
  • Phone: 803-236-2034
  • Fax: 803-808-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3520
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: