Provider Demographics
NPI:1386814176
Name:ROGER J SZANTO DMD
Entity Type:Organization
Organization Name:ROGER J SZANTO DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SZANTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-288-6500
Mailing Address - Street 1:181 BOULEVARD
Mailing Address - Street 2:WACHOVIA BUILDING SUITE 2C
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1843
Mailing Address - Country:US
Mailing Address - Phone:201-288-6500
Mailing Address - Fax:
Practice Address - Street 1:181 BOULEVARD
Practice Address - Street 2:WACHOVIA BUILDING SUITE 2C
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1843
Practice Address - Country:US
Practice Address - Phone:201-288-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11868NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty