Provider Demographics
NPI:1629132063
Name:SIMONIAN, ROGER B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:B
Last Name:SIMONIAN
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 1:7375 N FRESNO ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2478
Mailing Address - Country:US
Mailing Address - Phone:559-440-0876
Mailing Address - Fax:559-440-0880
Practice Address - Street 1:7375 N FRESNO ST STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2478
Practice Address - Country:US
Practice Address - Phone:559-440-0876
Practice Address - Fax:559-440-0880
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23562CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice