Provider Demographics
NPI:1003972001
Name:ROAN, AARON THOMAS (DMD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:THOMAS
Last Name:ROAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 PARK CENTER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-3005
Mailing Address - Country:US
Mailing Address - Phone:814-234-6826
Mailing Address - Fax:814-234-2497
Practice Address - Street 1:2590 PARK CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-3005
Practice Address - Country:US
Practice Address - Phone:814-234-6826
Practice Address - Fax:814-234-2497
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice