Provider Demographics
NPI:1174736326
Name:KELLOGG, RODNEY JAMES (DDS)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:JAMES
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5381 E BEHYMER AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9565
Mailing Address - Country:US
Mailing Address - Phone:559-322-6060
Mailing Address - Fax:559-322-7888
Practice Address - Street 1:1879 E FIR AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3841
Practice Address - Country:US
Practice Address - Phone:559-322-6060
Practice Address - Fax:559-322-7888
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist