Healthcare Provider Details

I. General information

NPI: 1083700389
Provider Name (Legal Business Name): WILLIAM EUGENE ROGERS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MARKET PLACE BLVD BLDG E
KNOXVILLE TN
37922-2337
US

IV. Provider business mailing address

140 MARKET PLACE BLVD BLDG E
KNOXVILLE TN
37922-2337
US

V. Phone/Fax

Practice location:
  • Phone: 865-693-2331
  • Fax: 865-691-8340
Mailing address:
  • Phone: 865-693-2331
  • Fax: 865-691-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2188
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: