Healthcare Provider Details

I. General information

NPI: 1780036814
Provider Name (Legal Business Name): TODD ROGERS DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 S REGAL ST
SPOKANE WA
99223-4648
US

IV. Provider business mailing address

3606 S REGAL ST
SPOKANE WA
99223-4648
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-4165
  • Fax: 509-838-6959
Mailing address:
  • Phone: 509-838-4165
  • Fax: 509-838-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00006531
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH00006298
License Number StateWA

VIII. Authorized Official

Name: FELISHA PEDERSON
Title or Position: MANAGER
Credential:
Phone: 509-838-4165