Provider Demographics
NPI:1922112333
Name:DOW, ROGER CHARLES (DMD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:CHARLES
Last Name:DOW
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 RAMSGATE SQ S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5871
Mailing Address - Country:US
Mailing Address - Phone:503-363-1712
Mailing Address - Fax:503-363-4346
Practice Address - Street 1:140 RAMSGATE SQ S
Practice Address - Street 2:SUITE 110
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5871
Practice Address - Country:US
Practice Address - Phone:503-363-1712
Practice Address - Fax:503-363-4346
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD64971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR112784Medicaid