Provider Demographics
NPI:1598996639
Name:ANDERSON, ROGER M (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 TRANSIT RD STE 120
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2611
Mailing Address - Country:US
Mailing Address - Phone:716-626-4427
Mailing Address - Fax:716-626-4875
Practice Address - Street 1:6105 TRANSIT RD STE 120
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2611
Practice Address - Country:US
Practice Address - Phone:716-626-4427
Practice Address - Fax:716-626-4875
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics