Provider Demographics
NPI:1528751252
Name:ROGERS, LANDON KYLE
Entity type:Individual
Prefix:DR
First Name:LANDON
Middle Name:KYLE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 RESEARCH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1089
Mailing Address - Country:US
Mailing Address - Phone:719-528-6450
Mailing Address - Fax:719-528-5834
Practice Address - Street 1:2465 RESEARCH PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1089
Practice Address - Country:US
Practice Address - Phone:719-528-6450
Practice Address - Fax:719-528-5834
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002055881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice