Active NPI
Jack Liam Rogan, DMD
- Dentist
- Fort Stewart, GA
National Provider Identifier
1700561636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10510
- Practice address
- 351 W 6TH Street
Fort Stewart, GA 31314 - Phone
- (912) 435-9185
- NPI assigned
- Jun 19, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10510 | SC | Primary |
Addresses
Primary practice location
351 W 6TH Street
Fort Stewart, GA 31314
Mailing address
615 Montgomery St Apt 131
Savannah, GA 31401-5405
Phone (314) 914-4227
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
| License | State | Type | Specialty |
|---|---|---|---|
| 10510 | SC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726617600000",
"number": "1700561636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 MONTGOMERY ST APT 131",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314015405",
"telephone_number": "314-914-4227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "351 W 6TH STREET",
"city": "FORT STEWART",
"state": "GA",
"postal_code": "31314",
"telephone_number": "912-435-9185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROGAN",
"first_name": "JACK",
"middle_name": "LIAM",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-19",
"last_updated": "2024-09-18",
"certification_date": "2024-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "10510",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.