Individual
KENNETH ROGERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1005 MAIN ST, SALMON, ID 83467-0947
(208) 756-4940
(208) 756-3381
Mailing address
PO BOX 947, SALMON, ID 83467-0947
(208) 756-4940
(208) 756-3381
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1790
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000792200
—
ID
Enumeration date
09/20/2006
Last updated
07/09/2007
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