Provider Demographics
NPI:1730217852
Name:ROGERS, STANLEY KIM (DMD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:KIM
Last Name:ROGERS
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 1:11 PROFESSIONALS CIR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678
Mailing Address - Country:US
Mailing Address - Phone:864-882-0134
Mailing Address - Fax:864-882-0135
Practice Address - Street 1:11 PROFESSIONALS CIR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-882-0134
Practice Address - Fax:864-882-0135
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2014-12-18
Deactivation Date:2007-03-22
Deactivation Code:
Reactivation Date:2014-12-18
Provider Licenses
StateLicense IDTaxonomies
SC2514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist