Provider Demographics
NPI:1902825979
Name:BEAN, ROGER DONALD (DDS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:DONALD
Last Name:BEAN
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 1:1331 W LACEY BLVD
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5904
Mailing Address - Country:US
Mailing Address - Phone:559-582-2893
Mailing Address - Fax:559-582-2898
Practice Address - Street 1:1331 W LACEY BLVD
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5904
Practice Address - Country:US
Practice Address - Phone:559-582-2893
Practice Address - Fax:559-582-2898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice