Provider Demographics
NPI:1871678730
Name:CULLEN, ROGER S (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:S
Last Name:CULLEN
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 1:25270 MARGUERITE PKWY
Mailing Address - Street 2:C
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-2910
Mailing Address - Country:US
Mailing Address - Phone:949-586-8530
Mailing Address - Fax:949-951-1407
Practice Address - Street 1:25270 MARGUERITE PKWY
Practice Address - Street 2:C
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-2910
Practice Address - Country:US
Practice Address - Phone:949-586-8530
Practice Address - Fax:949-951-1407
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24220122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist