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NPI Code Detail

MEDICARE: DR. ROGER PAUL FIELDMAN D.D.S.

MEDICARE: DR. ROGER PAUL FIELDMAN D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry26632CA

General Provider Information

NPI Number : 1649305301
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROGER PAUL FIELDMAN D.D.S.
Provider Business Mailing Address
First Line : 130 S ALVARADO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2238
Country : US
Telephone Number : 213-484-9660
Fax Number : 213-484-8317
Provider Business Practice Location Address
First Line : 130 S ALVARADO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90057-2238
Country : US
Telephone Number : 213-484-9660
Fax Number : 213-484-8317
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2007
Last Update Date : 07/08/2007

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