Provider Demographics
NPI:1295741478
Name:BROWN, ROGER J (DMD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:J
Last Name:BROWN
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 1:1614 GRAND AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3859
Mailing Address - Country:US
Mailing Address - Phone:970-945-9499
Mailing Address - Fax:970-928-0726
Practice Address - Street 1:1614 GRAND AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3859
Practice Address - Country:US
Practice Address - Phone:970-945-9499
Practice Address - Fax:970-928-0726
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71421223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics