=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629294871
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNIS L. ROGINSON D.D.S., M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4409 MING AVE
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93309-4817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-835-5800
-----------------------------------------------------
Fax | 661-835-0378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23904-B DE VILLE WAY
-----------------------------------------------------
City | MALIBU
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90265-4852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-636-7786
-----------------------------------------------------
Fax | 310-456-0969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 16255
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------