Provider Demographics
NPI:1417031972
Name:DUNPHY, ROGER A (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:DUNPHY
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 1:6306 WHISKEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8710
Mailing Address - Country:US
Mailing Address - Phone:239-481-7493
Mailing Address - Fax:239-481-6649
Practice Address - Street 1:6306 WHISKEY CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8710
Practice Address - Country:US
Practice Address - Phone:239-481-7493
Practice Address - Fax:239-481-6649
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN6777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist