Individual
JACOB H ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6521 PARADISE BLVD NW STE M, ALBUQUERQUE, NM 87114-6199
(505) 890-3000
Mailing address
6521 PARADISE BLVD NW STE M, ALBUQUERQUE, NM 87114-6199
(505) 350-3786
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3645
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2011
Last updated
05/08/2015
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