Provider Demographics
NPI:1073648556
Name:WEST, ROGER H (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:H
Last Name:WEST
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 1:2955 N MOORPARK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4568
Mailing Address - Country:US
Mailing Address - Phone:805-492-5050
Mailing Address - Fax:805-436-1217
Practice Address - Street 1:2955 N MOORPARK RD
Practice Address - Street 2:SUITE B
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4568
Practice Address - Country:US
Practice Address - Phone:805-492-5050
Practice Address - Fax:805-436-1217
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2067122300000X
CA50397122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist