Provider Demographics
NPI:1013330182
Name:ROGER B. ELTON, D.D.S., P.C.
Entity Type:Organization
Organization Name:ROGER B. ELTON, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:B
Authorized Official - Last Name:ELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-841-2100
Mailing Address - Street 1:10522 S PARKER RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9035
Mailing Address - Country:US
Mailing Address - Phone:303-841-2100
Mailing Address - Fax:303-841-2220
Practice Address - Street 1:10522 S PARKER RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9035
Practice Address - Country:US
Practice Address - Phone:303-841-2100
Practice Address - Fax:303-841-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty