Provider Demographics
NPI:1336106749
Name:CHENEY, ROGER DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DEAN
Last Name:CHENEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E CAVANAUGH RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-5624
Mailing Address - Country:US
Mailing Address - Phone:517-394-4040
Mailing Address - Fax:517-394-7648
Practice Address - Street 1:900 E CAVANAUGH RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-5624
Practice Address - Country:US
Practice Address - Phone:517-394-4040
Practice Address - Fax:517-394-7648
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12577122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist