Individual
DR. BRUCE J ROGOVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0314207
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0314207
—
OH
01
—
311035868027
CARESOURCE-MEDICAID
OH
Enumeration date
12/15/2006
Last updated
07/08/2007
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