Provider Demographics
NPI:1497834774
Name:LAMONTAGNE, ROGER A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:LAMONTAGNE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 JEWETT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103
Mailing Address - Country:US
Mailing Address - Phone:603-622-7973
Mailing Address - Fax:603-666-0613
Practice Address - Street 1:252 JEWETT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103
Practice Address - Country:US
Practice Address - Phone:603-622-7973
Practice Address - Fax:603-666-0613
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH21061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30004874Medicare ID - Type Unspecified