Provider Demographics
NPI:1033906383
Name:ROGERS, BROOKE GRICE (DMD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:GRICE
Last Name:ROGERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WEDGEPARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7812
Mailing Address - Country:US
Mailing Address - Phone:803-730-5650
Mailing Address - Fax:
Practice Address - Street 1:4 WEDGEPARK RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7812
Practice Address - Country:US
Practice Address - Phone:803-730-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-21
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC110501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice