Provider Demographics
NPI:1235315862
Name:WEBSTER, ROSCOE W JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSCOE
Middle Name:W
Last Name:WEBSTER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROCK
Other - Middle Name:W
Other - Last Name:WEBSTER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:201 E MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1366
Mailing Address - Country:US
Mailing Address - Phone:419-884-0011
Mailing Address - Fax:419-884-0016
Practice Address - Street 1:201 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-1366
Practice Address - Country:US
Practice Address - Phone:419-884-0011
Practice Address - Fax:419-884-0016
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist