Provider Demographics
NPI:1083149942
Name:ROAR ASSOCIATES INC.
Entity Type:Organization
Organization Name:ROAR ASSOCIATES INC.
Other - Org Name:A DENTAL PRACTICE OF GANNON LEE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GANNON
Authorized Official - Middle Name:KA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-448-7667
Mailing Address - Street 1:26302 LA PAZ RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5313
Mailing Address - Country:US
Mailing Address - Phone:949-448-7667
Mailing Address - Fax:949-586-6525
Practice Address - Street 1:26302 LA PAZ RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-448-7667
Practice Address - Fax:949-586-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS14162122300000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty