Provider Demographics
NPI:1730302704
Name:MEYER, ROGER N (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:N
Last Name:MEYER
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 1:6665 DELMONICO DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919
Mailing Address - Country:US
Mailing Address - Phone:719-599-5700
Mailing Address - Fax:719-260-5685
Practice Address - Street 1:6665 DELMONICO DR
Practice Address - Street 2:SUITE C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-6801
Practice Address - Country:US
Practice Address - Phone:719-599-5700
Practice Address - Fax:719-260-5685
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice