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NPI Code Detail

MEDICARE: TERRI LYNN ROGERS D.D.S.

MEDICARE: TERRI LYNN 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
11223G0001XGeneral Practice Dentistry37599CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1671459OTHERUNITED CONCORDIA

General Provider Information

NPI Number : 1790842417
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRI LYNN ROGERS D.D.S.
Provider Business Mailing Address
First Line : 6820 LA TIJERA BLVD STE 205
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-1931
Country : US
Telephone Number : 310-670-2200
Fax Number : 310-670-3189
Provider Business Practice Location Address
First Line : 6820 LA TIJERA BLVD STE 205
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-1931
Country : US
Telephone Number : 310-670-2200
Fax Number : 310-670-3189
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 07/08/2007

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