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General NPI Number Information
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NPI Number | 1609980036
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Entity Type | Individual
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Provider Name | JASON SCOTT ROGERS DMD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 810 E MAIN ST SUITE G
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City | LAURENS
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State | SC
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Zip | 29360-3535
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Country | US
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Telephone | 864-715-0688
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Fax |
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Provider Business Mailing Address
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Address Line | 810 E MAIN ST STE G
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City | LAURENS
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State | SC
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Zip | 29360-3547
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Country | US
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Telephone | 864-200-1999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4024
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License Number State | SC
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