Provider Demographics
NPI:1194874370
Name:ROGERS, ROBERT RICHARD III (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RICHARD
Last Name:ROGERS
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11676 PERRY HWY
Mailing Address - Street 2:SUITE 3201
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7201
Mailing Address - Country:US
Mailing Address - Phone:724-935-6670
Mailing Address - Fax:724-935-6758
Practice Address - Street 1:11676 PERRY HWY
Practice Address - Street 2:SUITE 3201
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7201
Practice Address - Country:US
Practice Address - Phone:724-935-6670
Practice Address - Fax:724-935-6758
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020317L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice