Individual
DR. ROY H ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
1564 S TIMESQUARE LN, BOISE, ID 83709-8266
(208) 376-8873
Mailing address
1564 S TIMESQUARE LN, BOISE, ID 83709-8266
(208) 376-8873
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D3725
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D3725
STATE LICENSE #
ID
Enumeration date
06/10/2006
Last updated
07/08/2007
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