Provider Demographics
NPI:1164593034
Name:PLOOSTER, ROGER D (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:D
Last Name:PLOOSTER
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 1:827 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3726
Mailing Address - Country:US
Mailing Address - Phone:402-486-0825
Mailing Address - Fax:402-486-4935
Practice Address - Street 1:827 S 48TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-3726
Practice Address - Country:US
Practice Address - Phone:402-486-0825
Practice Address - Fax:402-486-4935
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47064792300Medicaid