=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700135407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN ROGERS DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2012
-----------------------------------------------------
Last Update Date | 09/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6802 S OLYMPIA AVE SUITE 275
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74132-1823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-408-9543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6802 S OLYMPIA AVE SUITE 275
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74132-1823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-408-9543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN M ROGERS
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 918-408-9543
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 6209
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------