Provider Demographics
NPI:1467498626
Name:ROESENER, STEPHAN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:ROBERT
Last Name:ROESENER
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 1:7950 N SHADELAND AVE
Mailing Address - Street 2:#400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2691
Mailing Address - Country:US
Mailing Address - Phone:317-849-9961
Mailing Address - Fax:317-577-9128
Practice Address - Street 1:7950 N SHADELAND AVE
Practice Address - Street 2:#400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2691
Practice Address - Country:US
Practice Address - Phone:317-849-9961
Practice Address - Fax:317-577-9128
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006893A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice