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General NPI Number Information
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NPI Number | 1568534881
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Entity Type | Organization
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Legal Business Name | ROGERS DENTAL ASSOCIATES,PLLC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2301 W WALNUT ST SUITE 15
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City | ROGERS
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State | AR
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Zip | 72756-3586
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Country | US
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Telephone | 479-633-0111
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Fax | 479-633-0156
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Provider Business Mailing Address
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Address Line | 2301 W WALNUT ST SUITE 15
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City | ROGERS
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State | AR
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Zip | 72756-3586
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Country | US
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Telephone | 479-633-0111
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Fax | 479-633-0156
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. LINDA L HEEP
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Credential |
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Telephone | 479-633-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2769,3578,3571
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License Number State | AR
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