Provider Demographics
NPI:1275748790
Name:ROHRER, CYNTHIA KAY (LD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAY
Last Name:ROHRER
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 N. MAIN ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754
Mailing Address - Country:US
Mailing Address - Phone:541-447-1593
Mailing Address - Fax:541-447-5437
Practice Address - Street 1:427 N. MAIN ST.
Practice Address - Street 2:SUITE A
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754
Practice Address - Country:US
Practice Address - Phone:541-447-1593
Practice Address - Fax:541-447-5437
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-403611122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist