MEDICARE: CHARLES ROSKAMP DDS

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	3861	OK

General Provider Information

NPI Number	:	1790925279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ROSKAMP DDS

Provider Business Mailing Address
First Line	:	3300 S ASPEN AVE
Second Line	:	SUITE A
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7501
Country	:	US
Telephone Number	:	918-451-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 S ASPEN AVE
Second Line	:	SUITE A
City	:	BROKEN ARROW
State	:	OK
Zip	:	74012-7501
Country	:	US
Telephone Number	:	918-451-0211
Fax Number	:

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

Provider Enumeration Date	:	02/24/2009
Last Update Date	:	01/18/2026

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Directions to “ CHARLES ROSKAMP DDS” Practice Location

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