1568534881 NPI number — ROGERS DENTAL ASSOCIATES,PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568534881 NPI number — ROGERS DENTAL ASSOCIATES,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGERS DENTAL ASSOCIATES,PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568534881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 W WALNUT ST
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
ROGERS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72756-3586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-633-0111
Provider Business Mailing Address Fax Number:
479-633-0156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 W WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE 15
Provider Business Practice Location Address City Name:
ROGERS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72756-3586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-633-0111
Provider Business Practice Location Address Fax Number:
479-633-0156
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEEP
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
479-633-0111

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2769,3578,3571 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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