Provider Demographics
NPI:1376711259
Name:WEBSTER, ROGER ALLAN (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:ALLAN
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 W BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8861
Mailing Address - Country:US
Mailing Address - Phone:559-622-0773
Mailing Address - Fax:559-622-0773
Practice Address - Street 1:200 W SHAW AVE STE 110
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3684
Practice Address - Country:US
Practice Address - Phone:559-325-6161
Practice Address - Fax:559-325-6166
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics