Theodora KK Rogers, DDS, PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

THEODORA KK ROGERS, DDS, PC

Practice address

1000 Bluff St
Fulton, MO 65251-2321

Phone

(573) 642-7234

NPI assigned

Jul 13, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Teddy KK Rogers, DDS

Title

Director

Phone

(816) 572-1973

Specialties & licenses 1

Addresses

Other names 1

• Gray Duck Dentistry Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Patrick D Neff, DDS

  • Dentist
  • Fulton, MO
  • NPI 1629162979
  NPD (past)
• Theodora Rogers, DDS

  • Dentist
  • Fulton, MO
  • NPI 1720430325
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468368000000",
    "number": "1013369115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 PREAKNESS DR",
            "city": "RAYMORE",
            "state": "MO",
            "postal_code": "640838472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLUFF ST",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652512321",
            "telephone_number": "573-642-7234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEODORA KK ROGERS, DDS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-13",
        "last_updated": "2016-07-13",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "TEDDY",
        "authorized_official_middle_name": "KK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "816-572-1973",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gray Duck Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Susan Langstraat LCSW LLC
• Alex Syverud
• Kaylee Tagart, PT
• Ashlee Taylor, MAT, LAT, ATC
• Randy L Telander, PH.D.
• Stephanie Thomas
• Joshua Stephen Thompson, ATC/LAT
• Samantha Paige Thompson, FNP-C
• Sophi Thurman, MD
• Carla Tigue

• Dental Clinic/Center in Fulton, MO
• Providers in Fulton, MO by specialty
• Dental Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.