MEDICARE: DR. ROBERTO ROGES 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	31368	CA

General Provider Information

NPI Number	:	1932499100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO ROGES D.D.S.

Provider Business Mailing Address
First Line	:	8540 S SEPULVEDA BLVD STE 1117
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3819
Country	:	US
Telephone Number	:	310-337-1388
Fax Number	:	310-337-0678

Provider Business Practice Location Address
First Line	:	8540 S SEPULVEDA BLVD STE 1117
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3819
Country	:	US
Telephone Number	:	310-337-1388
Fax Number	:	310-337-0678

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

Provider Enumeration Date	:	04/08/2011
Last Update Date	:	04/08/2011

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