Provider Demographics
NPI:1063452134
Name:SPOTT, ROGER J (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:J
Last Name:SPOTT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7407
Mailing Address - Country:US
Mailing Address - Phone:561-488-1862
Mailing Address - Fax:
Practice Address - Street 1:2242 W ATLANTIC AVE
Practice Address - Street 2:GENTLE DENTAL GROUP
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4637
Practice Address - Country:US
Practice Address - Phone:561-272-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 48521223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics