Healthcare Provider Details

I. General information

NPI: 1659660397
Provider Name (Legal Business Name): RAMON G ROGES II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W 34TH ST
LOS ANGELES CA
90089-0641
US

IV. Provider business mailing address

925 W 34TH ST
LOS ANGELES CA
90089-0641
US

V. Phone/Fax

Practice location:
  • Phone: 213-740-9011
  • Fax: 213-740-6627
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number33984
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: