Individual provider Active NPI

Rowan Fogerty, DMD

  • General Practice Dentistry
  • Phoenix, AZ
National Provider Identifier
1053208660
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D012545 Issued in AZ
Practice address
3750 W Greenway Rd
Phoenix, AZ 85053-3703
Phone
(602) 466-2202
NPI assigned
Jun 18, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D012545 AZ Primary

Addresses

Primary practice location

3750 W Greenway Rd
Phoenix, AZ 85053-3703

Mailing address

5627 W Tonopah Dr
Glendale, AZ 85308-9108
Phone (406) 631-0117

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D012545AZMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dental Depot Ortho Greenway PLLC CurrentSince Jun 23, 2025 Accepting new patients

Locations

3750 W Greenway Rd
Phoenix, AZ 85053
Phone (602) 223-1832

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1750204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750204800000",
    "number": "1053208660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5627 W TONOPAH DR",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853089108",
            "telephone_number": "406-631-0117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3750 W GREENWAY RD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850533703",
            "telephone_number": "602-466-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGERTY",
        "first_name": "ROWAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-18",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D012545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; 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.