MEDICARE: DR. ROGER VANSANTEN 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	122300000X	Dentist	4785	OR

General Provider Information

NPI Number	:	1487722195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER VANSANTEN D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 455
Second Line	:
City	:	STAYTON
State	:	OR
Zip	:	97383-0455
Country	:	US
Telephone Number	:	503-581-7173
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 E WASHINGTON ST
Second Line	:
City	:	STAYTON
State	:	OR
Zip	:	97383-0455
Country	:	US
Telephone Number	:	503-769-6351
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. ROGER VANSANTEN D.D.S.” Practice Location

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