# THEODORA KK ROGERS, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gray Duck Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013369115
- **Authorized official:** DR. TEDDY KK ROGERS DDS (DIRECTOR)
- **Authorized official phone:** (816) 572-1973

## Contact information

- **Practice address:** 1000 BLUFF ST, FULTON, MO 65251-2321
- **Practice address phone:** (573) 642-7234
- **Mailing address:** 505 PREAKNESS DR, RAYMORE, MO 64083-8472

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/13/2016
- **Last updated:** 07/13/2016