Healthcare Provider Details

I. General information

NPI: 1700894300
Provider Name (Legal Business Name): ROGER BADWAL DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 NEWTOWN RD
DANBURY CT
06810-4146
US

IV. Provider business mailing address

107 NEWTOWN RD
DANBURY CT
06810-4146
US

V. Phone/Fax

Practice location:
  • Phone: 203-797-0012
  • Fax: 203-797-0123
Mailing address:
  • Phone: 203-797-0012
  • Fax: 203-797-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number008387
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number8387
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: