Provider Demographics
NPI:1225247679
Name:ROGER A. FINE, D.D.S., P.A.
Entity Type:Organization
Organization Name:ROGER A. FINE, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-558-2321
Mailing Address - Street 1:1800 W 49TH ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2900
Mailing Address - Country:US
Mailing Address - Phone:305-558-2321
Mailing Address - Fax:
Practice Address - Street 1:1800 W 49TH ST
Practice Address - Street 2:SUITE 314
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2900
Practice Address - Country:US
Practice Address - Phone:305-558-2321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 51891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty