Provider Demographics
NPI:1720175078
Name:ROGERS, DAVID ALONZO (DMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALONZO
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 1:517 GEORGIAN DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-3432
Mailing Address - Country:US
Mailing Address - Phone:251-342-7781
Mailing Address - Fax:251-342-9440
Practice Address - Street 1:517 GEORGIAN DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3432
Practice Address - Country:US
Practice Address - Phone:251-342-7781
Practice Address - Fax:251-342-9440
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL30141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice