Provider Demographics
NPI:1366555609
Name:ROGERS, GEORGIA GRACE (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:GRACE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:DR
Other - First Name:GEORGIA
Other - Middle Name:GRACE
Other - Last Name:DELACRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MPH
Mailing Address - Street 1:6455 MACHINE STREET
Mailing Address - Street 2:APG DENTAL CLINIC
Mailing Address - City:ABERDEEN PROVING GROUND
Mailing Address - State:MD
Mailing Address - Zip Code:21005
Mailing Address - Country:US
Mailing Address - Phone:410-278-1795
Mailing Address - Fax:410-278-5577
Practice Address - Street 1:6455 MACHINE STREET
Practice Address - Street 2:APG DENTAL CLINIC
Practice Address - City:ABERDEEN PROVING GROUND
Practice Address - State:MD
Practice Address - Zip Code:21005
Practice Address - Country:US
Practice Address - Phone:410-278-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-028395-L1223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health