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General NPI Number Information
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NPI Number | 1013369115
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Entity Type | Organization
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Legal Business Name | THEODORA KK ROGERS, DDS, PC
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 1000 BLUFF ST
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City | FULTON
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State | MO
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Zip | 65251-2321
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Country | US
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Telephone | 573-642-7234
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Fax |
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Provider Business Mailing Address
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Address Line | 505 PREAKNESS DR
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City | RAYMORE
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State | MO
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Zip | 64083-8472
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. TEDDY KK ROGERS
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Credential | DDS
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Telephone | 816-572-1973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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