Provider Demographics
NPI:1326262593
Name:MEAD, ROGER ALAN II (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:ALAN
Last Name:MEAD
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3240 CHRISTY WAY S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2215
Mailing Address - Country:US
Mailing Address - Phone:989-799-9133
Mailing Address - Fax:989-497-8110
Practice Address - Street 1:3240 CHRISTY WAY S
Practice Address - Street 2:SUITE 5
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2215
Practice Address - Country:US
Practice Address - Phone:989-799-9133
Practice Address - Fax:989-497-8110
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010172751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice