Provider Demographics
NPI:1881140473
Name:ROGOWSKI, LEAH (DMD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:
Last Name:ROGOWSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 S RIATA ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2928
Mailing Address - Country:US
Mailing Address - Phone:480-220-3894
Mailing Address - Fax:
Practice Address - Street 1:2963 W ELLIOT RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1633
Practice Address - Country:US
Practice Address - Phone:480-220-3894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0112411223X0400X
FLDN 22123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics