Provider Demographics
NPI:1871698456
Name:RODGERS, RICKY JOE (DDS)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:JOE
Last Name:RODGERS
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:UNITED STATES MILITARY ACADEMY
Mailing Address - Street 2:DENTAC, 646 SWIFT RD
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1905
Mailing Address - Country:US
Mailing Address - Phone:845-938-2449
Mailing Address - Fax:845-938-4302
Practice Address - Street 1:US ARMY DENTAL ACTIVITY
Practice Address - Street 2:DENTAC, BLDG 606, 1ST FLOOR
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1905
Practice Address - Country:US
Practice Address - Phone:845-938-2449
Practice Address - Fax:845-938-4302
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX126191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics