Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 0401008185 | VA |
NPI | 1053325340 |
---|---|
Provider Name | Dr. Rod Michael Rogge |
First Address | Virginia Beach, VA 23455-6200 |
Second Address | Virginia Beach, VA 23455-6200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 08/07/2007 |