Provider Demographics
NPI:1922839737
Name:ROGICH, AUNDREA NICOLE (RDH)
Entity type:Individual
Prefix:
First Name:AUNDREA
Middle Name:NICOLE
Last Name:ROGICH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 AGATE CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3690
Mailing Address - Country:US
Mailing Address - Phone:970-396-3033
Mailing Address - Fax:
Practice Address - Street 1:617 E EISENHOWER BLVD STE 653
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3919
Practice Address - Country:US
Practice Address - Phone:970-396-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000904289124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist