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NPI Code Detail

MEDICARE: DR. MARK ROGERS D.M.D.

MEDICARE: DR. MARK ROGERS D.M.D.
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
11223G0001XGeneral Practice DentistryD6365OR

General Provider Information

NPI Number : 1700825247
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK ROGERS D.M.D.
Provider Business Mailing Address
First Line : 1678 LIBERTY ST SE
Second Line : SUITE 101
City : SALEM
State : OR
Zip : 97302-4348
Country : US
Telephone Number : 503-362-1515
Fax Number : 503-316-3929
Provider Business Practice Location Address
First Line : 1678 LIBERTY ST SE
Second Line : SUITE 101
City : SALEM
State : OR
Zip : 97302-4348
Country : US
Telephone Number : 503-362-1515
Fax Number : 503-316-3929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 07/08/2007

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