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General NPI Number Information
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NPI Number | 1194802728
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Entity Type | Individual
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Provider Name | ROGER W.K. JOE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 17437 CHATSWORTH STREET
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City | GRANADA HILLS
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State | CA
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Zip | 91344
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Country | US
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Telephone | 818-312-0829
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Fax |
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Provider Business Mailing Address
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Address Line | 19872 FALCON CREST WAY
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City | PORTER RANCH
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State | CA
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Zip | 91326-4030
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Country | US
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Telephone | 818-366-2802
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40249
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License Number State | CA
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