Organization
RICHARD L. RODGERS, D.D.S., M.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD LEE RODGERS D.D.S., M.S. (OWNER/PERIODONTIST)
(712) 255-0088
Entity
Organization
Contact information
Practice address
2912 HAMILTON BLVD, SUITE 103, SIOUX CITY, IA 51104-2410
(712) 255-0088
Mailing address
2912 HAMILTON BLVD, SUITE 103, SIOUX CITY, IA 51104-2410
(712) 255-0088
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
6596
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23319
MEDICARE ID-TYPE UNSPECIFIED
IA
Enumeration date
05/23/2008
Last updated
05/23/2008
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