MEDICARE: ROBERT PODMORE ROGERS 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	1223G0001X	General Practice Dentistry	30145	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G9262301	OTHER	CA	MEDI CAL

General Provider Information

NPI Number	:	1376606764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT PODMORE ROGERS D.D.S.

Provider Business Mailing Address
First Line	:	1781 REDWOOD RD
Second Line	:
City	:	HERCULES
State	:	CA
Zip	:	94547-1338
Country	:	US
Telephone Number	:	510-799-4901
Fax Number	:	925-939-6100

Provider Business Practice Location Address
First Line	:	764 GRAYSON RD STE B
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-2686
Country	:	US
Telephone Number	:	925-939-6100
Fax Number	:	925-939-6122

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/08/2007

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