Provider Demographics
NPI:1508912346
Name:SEPICH, ROGER M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:M
Last Name:SEPICH
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 1:559 WEST MAIN STREET
Mailing Address - Street 2:P.O. BOX 715
Mailing Address - City:SAXONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16056
Mailing Address - Country:US
Mailing Address - Phone:724-352-4440
Mailing Address - Fax:724-352-0218
Practice Address - Street 1:559 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAXONBURG
Practice Address - State:PA
Practice Address - Zip Code:16056
Practice Address - Country:US
Practice Address - Phone:724-352-4440
Practice Address - Fax:724-352-0218
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025777L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA427377OtherUNITED CONCORDIA #