MEDICARE: ROGER J SPOTT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	DN 4852	FL

General Provider Information

NPI Number	:	1063452134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER J SPOTT D.D.S.

Provider Business Mailing Address
First Line	:	7315 VALENCIA DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-7407
Country	:	US
Telephone Number	:	561-488-1862
Fax Number	:

Provider Business Practice Location Address
First Line	:	6805 PEMBROKE RD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33023-2620
Country	:	US
Telephone Number	:	954-989-6950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	05/13/2024

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