Provider Demographics
NPI:1871578799
Name:ROGOL, NEAL WAYNE (DMD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:WAYNE
Last Name:ROGOL
Suffix:
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 1:2343 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4703
Mailing Address - Country:US
Mailing Address - Phone:401-333-2700
Mailing Address - Fax:401-334-3369
Practice Address - Street 1:2343 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4703
Practice Address - Country:US
Practice Address - Phone:401-333-2700
Practice Address - Fax:401-334-3369
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI19981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice