Provider Demographics
NPI:1548343718
Name:RICHARD L RODGERS II DDS PC
Entity type:Organization
Organization Name:RICHARD L RODGERS II DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-870-0317
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1115
Mailing Address - City:ALTANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-577-6620
Mailing Address - Fax:404-577-7871
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1115
Practice Address - City:ALTANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-577-6620
Practice Address - Fax:404-577-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA101691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty