Provider Demographics
NPI:1518009208
Name:ROFFE, ALLAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:
Last Name:ROFFE
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 1:289 MEADOWVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2106
Mailing Address - Country:US
Mailing Address - Phone:516-295-2257
Mailing Address - Fax:
Practice Address - Street 1:56 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5038
Practice Address - Country:US
Practice Address - Phone:516-208-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0450681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01574827Medicaid
NY464065203OtherTAX
NY050591694OtherTAXID