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General NPI Number Information
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NPI Number | 1720100571
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Entity Type | Individual
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Provider Name | DUANE RODGERS-PEREZ MATA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 660 BANNOCK ST # L
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City | DENVER
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State | CO
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Zip | 80204-4506
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Country | US
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Telephone | 303-436-4949
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Fax | 303-602-4064
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Provider Business Mailing Address
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Address Line | 7150 E HAMPDEN AVE STE 104
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City | DENVER
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State | CO
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Zip | 80224-3026
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Country | US
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Telephone | 303-758-9511
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Fax | 303-758-3834
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN.00008291
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License Number State | CO
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