MEDICARE: PAUL NICHOLAS 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	KS5511	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	008982	OTHER	KS	BLUE CROSS BLUE SHIELD
3	480951021	OTHER	KY	DELTA DENTAL

General Provider Information

NPI Number	:	1487650511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL NICHOLAS ROGERS D.D.S.

Provider Business Mailing Address
First Line	:	1939 N 11TH ST
Second Line	:
City	:	ARKANSAS CITY
State	:	KS
Zip	:	67005-1724
Country	:	US
Telephone Number	:	620-442-5660
Fax Number	:	620-442-5682

Provider Business Practice Location Address
First Line	:	1939 N 11TH ST
Second Line	:
City	:	ARKANSAS CITY
State	:	KS
Zip	:	67005-1724
Country	:	US
Telephone Number	:	620-442-5660
Fax Number	:	620-442-5682

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	01/22/2015

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