Provider Demographics
NPI:1710075262
Name:STINE, ROGER D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:STINE
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 1:102 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-1821
Mailing Address - Country:US
Mailing Address - Phone:419-663-0070
Mailing Address - Fax:419-499-4993
Practice Address - Street 1:102 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-1821
Practice Address - Country:US
Practice Address - Phone:419-663-0070
Practice Address - Fax:419-499-4993
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300207811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30020781OtherSTATE DENTAL LICENSE #