Provider Demographics
NPI:1962958405
Name:ROGERS, HARRY M
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:M
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
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Other - Credentials:
Mailing Address - Street 1:398 192ND ARMORED TANK BN RD
Mailing Address - Street 2:USA DENTAC HEADQUARTERS BLDG 1022
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5116
Mailing Address - Country:US
Mailing Address - Phone:502-624-6158
Mailing Address - Fax:502-624-2966
Practice Address - Street 1:962 1ST INFANTRY DIVISION RD
Practice Address - Street 2:JORDAN DENTAL CLINIC BLDG 2724
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5210
Practice Address - Country:US
Practice Address - Phone:502-626-8301
Practice Address - Fax:502-626-8300
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant