Provider Demographics
NPI:1659164747
Name:RODGERS, PATRICK (DMD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:RODGERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 46TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-3954
Mailing Address - Country:US
Mailing Address - Phone:727-501-6662
Mailing Address - Fax:
Practice Address - Street 1:5216 SHERIDAN ST STE 160
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-3972
Practice Address - Country:US
Practice Address - Phone:563-724-5427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-103391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice