Provider Demographics
NPI:1942551791
Name:ROGER C. DOW, DMD PC
Entity Type:Organization
Organization Name:ROGER C. DOW, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-363-1712
Mailing Address - Street 1:140 RAMSGATE SQ SE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-363-1712
Mailing Address - Fax:503-363-4346
Practice Address - Street 1:140 RAMSGATE SQ SE
Practice Address - Street 2:SUITE 110
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-363-1712
Practice Address - Fax:503-363-4346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD64971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR112784Medicaid