Provider Demographics
NPI:1972507234
Name:OPPENHEIMER, ROGER E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:E
Last Name:OPPENHEIMER
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 1:12 CHIMNEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:CT
Mailing Address - Zip Code:06784-1307
Mailing Address - Country:US
Mailing Address - Phone:860-866-8100
Mailing Address - Fax:
Practice Address - Street 1:12 CHIMNEY HILL RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:CT
Practice Address - Zip Code:06784-1307
Practice Address - Country:US
Practice Address - Phone:860-866-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317591223G0001X
CT010927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01199086Medicaid