Provider Demographics
NPI:1902326523
Name:ROGERS, JOSEPH JORDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JORDAN
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SPENCE ENCLAVE CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-3244
Mailing Address - Country:US
Mailing Address - Phone:615-973-2002
Mailing Address - Fax:
Practice Address - Street 1:2153 GALLATIN PIKE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2003
Practice Address - Country:US
Practice Address - Phone:615-953-8946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2017-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN105411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice