Provider Demographics
NPI:1033709464
Name:ROGER B. WEI, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROGER B. WEI, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-491-3620
Mailing Address - Street 1:2225 PLAZA PKWY STE C12
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6218
Mailing Address - Country:US
Mailing Address - Phone:209-491-3620
Mailing Address - Fax:
Practice Address - Street 1:2225 PLAZA PKWY STE C12
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6218
Practice Address - Country:US
Practice Address - Phone:209-491-3620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty