MEDICARE: DR. ROD MICHAEL ROGGE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	0401008185	VA

General Provider Information

NPI Number	:	1053325340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROD MICHAEL ROGGE D.D.S.

Provider Business Mailing Address
First Line	:	762 INDEPENDENCE BLVD
Second Line	:	SUITE #500
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6200
Country	:	US
Telephone Number	:	757-333-7444
Fax Number	:	757-962-9470

Provider Business Practice Location Address
First Line	:	762 INDEPENDENCE BLVD
Second Line	:	SUITE #500
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6200
Country	:	US
Telephone Number	:	757-333-7444
Fax Number	:	757-962-9470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/08/2007

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