Provider Demographics
NPI:1790855245
Name:ALLEN, ROGER DIMAGGIO (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:DIMAGGIO
Last Name:ALLEN
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:PO BOX 31097
Mailing Address - Street 2:525 EASTER AVE
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743
Mailing Address - Country:US
Mailing Address - Phone:301-636-9684
Mailing Address - Fax:301-636-9686
Practice Address - Street 1:525 EASTER AVE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743
Practice Address - Country:US
Practice Address - Phone:301-636-9684
Practice Address - Fax:301-636-9686
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD74981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice