Provider Demographics
NPI:1861656274
Name:TUBBESING, ROGER HENRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:HENRY
Last Name:TUBBESING
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 1:233 A ST
Mailing Address - Street 2:SUITE 701
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-4007
Mailing Address - Country:US
Mailing Address - Phone:619-232-3774
Mailing Address - Fax:619-232-5214
Practice Address - Street 1:233 A ST
Practice Address - Street 2:SUITE 701
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4007
Practice Address - Country:US
Practice Address - Phone:619-232-3774
Practice Address - Fax:619-232-5214
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA193931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice