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General NPI Number Information
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NPI Number | 1487072708
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Entity Type | Organization
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Legal Business Name | ROLLAND ROGERS DDS ESTATE
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 10850 71ST AVE STE 1G
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City | FOREST HILLS
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State | NY
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Zip | 11375-4524
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Country | US
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Telephone | 718-268-3666
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Fax | 718-268-7785
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Provider Business Mailing Address
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Address Line | 10850 71ST AVE STE 1G
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City | FOREST HILLS
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State | NY
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Zip | 11375-4524
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Country | US
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Telephone | 718-268-3666
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Fax | 718-268-7785
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. EMILIA ROGERS
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Credential |
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Telephone | 917-912-7139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 056612
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License Number State | NY
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