Provider Demographics
NPI:1558585851
Name:ROPER, RAYMOND CLINTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:CLINTON
Last Name:ROPER
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 1:1900 FOLSOM ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5713
Mailing Address - Country:US
Mailing Address - Phone:303-447-2281
Mailing Address - Fax:
Practice Address - Street 1:1900 FOLSOM ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5713
Practice Address - Country:US
Practice Address - Phone:303-447-2281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5916122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5916OtherSTATE LICENSE NUMBER