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General NPI Number Information
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NPI Number | 1902269640
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Entity Type | Organization
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Legal Business Name | DR. ROGER ANDREWS, PLLC
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 3521 W OWEN K GARRIOTT RD
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City | ENID
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State | OK
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Zip | 73703-4910
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Country | US
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Telephone | 580-540-3580
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Fax | 580-237-3179
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220-3189
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Country | US
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Telephone | 315-454-6000
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Fax | 315-410-5531
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Authorized Official
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Title or Position | OWNER
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Name | ROGER ANDREWS
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Credential | DDS
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Telephone | 580-540-3580
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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 | 4803
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License Number State | OK
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