Provider Demographics
NPI:1417582701
Name:ROGERSON, LESLEE (RDH)
Entity type:Individual
Prefix:
First Name:LESLEE
Middle Name:
Last Name:ROGERSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8579 IVOR ROAD
Mailing Address - Street 2:
Mailing Address - City:IVOR
Mailing Address - State:VA
Mailing Address - Zip Code:23866
Mailing Address - Country:US
Mailing Address - Phone:757-859-9070
Mailing Address - Fax:
Practice Address - Street 1:8579 IVOR ROAD
Practice Address - Street 2:
Practice Address - City:IVOR
Practice Address - State:VA
Practice Address - Zip Code:23866
Practice Address - Country:US
Practice Address - Phone:757-859-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402207706124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist