Provider Demographics
NPI:1285794065
Name:ROGERS, EARL D (DMD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:D
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4736 AIRPORT BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608
Mailing Address - Country:US
Mailing Address - Phone:251-344-7096
Mailing Address - Fax:251-344-7153
Practice Address - Street 1:4736 AIRPORT BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-344-7096
Practice Address - Fax:251-344-7153
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL33847OtherBCBS PROVIDER NUMBER