Provider Demographics
NPI:1487044111
Name:ROGER L. GAUSE DDS
Entity Type:Organization
Organization Name:ROGER L. GAUSE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-762-5961
Mailing Address - Street 1:415 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4103
Mailing Address - Country:US
Mailing Address - Phone:910-762-5961
Mailing Address - Fax:910-762-8115
Practice Address - Street 1:415 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4103
Practice Address - Country:US
Practice Address - Phone:910-762-5961
Practice Address - Fax:910-762-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty