MEDICARE: DR. JAMES ROGERS D.D.S., M.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	S4-22	NV

General Provider Information

NPI Number	:	1710259254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ROGERS D.D.S., M.S.

Provider Business Mailing Address
First Line	:	3575 S TOWN CENTER DR
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3045
Country	:	US
Telephone Number	:	702-966-0300
Fax Number	:	702-932-5144

Provider Business Practice Location Address
First Line	:	3575 S TOWN CENTER DR
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3045
Country	:	US
Telephone Number	:	702-966-0300
Fax Number	:	702-932-5144

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

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	01/30/2012

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