Provider Demographics
NPI:1861543480
Name:ROGERS, RAYMOND LEWIS JR (DMD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LEWIS
Last Name:ROGERS
Suffix:JR
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 1:300 GATLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6951
Mailing Address - Country:US
Mailing Address - Phone:407-857-4244
Mailing Address - Fax:407-857-2204
Practice Address - Street 1:300 GATLIN AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6951
Practice Address - Country:US
Practice Address - Phone:407-857-4244
Practice Address - Fax:407-857-2204
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN74041223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics