MEDICARE: DR. KARRY E ROGUS 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	122300000X	Dentist	21399	OH

General Provider Information

NPI Number	:	1891120838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARRY E ROGUS D.D.S.

Provider Business Mailing Address
First Line	:	1063 S COURT ST
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-2824
Country	:	US
Telephone Number	:	330-725-0581
Fax Number	:	330-721-0146

Provider Business Practice Location Address
First Line	:	1063 SOUTH COURT DENTAL
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-2824
Country	:	US
Telephone Number	:	330-725-0581
Fax Number	:	330-721-0146

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

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	07/21/2022

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