Provider Demographics
NPI:1194845602
Name:ELTON, ROGER B (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:B
Last Name:ELTON
Suffix:
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5657 S HIMALAYA ST STE 110
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5308
Mailing Address - Country:US
Mailing Address - Phone:303-364-6433
Mailing Address - Fax:303-699-8246
Practice Address - Street 1:5657 S HIMALAYA ST STE 110
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-5308
Practice Address - Country:US
Practice Address - Phone:303-364-6433
Practice Address - Fax:303-699-8246
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics