Healthcare Provider Details

I. General information

NPI: 1184699126
Provider Name (Legal Business Name): ROGER WILLIAM KANE JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 FORREST AVE
DOVER DE
19904
US

IV. Provider business mailing address

PO BOX 151
NEW CASTLE DE
19720-0151
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-2455
  • Fax: 302-322-6251
Mailing address:
  • Phone: 302-652-2455
  • Fax: 302-322-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1-0001220
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: