Basic Information
| Provider Information | |||||||||
| NPI: | 1184683906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROGERSON | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | WEST LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037841681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032987557 | ||||||||
| FaxNumber: | 8888573155 | ||||||||
| Practice Location | |||||||||
| Address1: | 16 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | WEST LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037841681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032987557 | ||||||||
| FaxNumber: | 8888573155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 03/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 2517 | NH | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.