Provider Demographics
NPI:1356353999
Name:HARKINS, ROGER HALL (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:HALL
Last Name:HARKINS
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 1:1111 E WHEEL RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6359
Mailing Address - Country:US
Mailing Address - Phone:443-371-7679
Mailing Address - Fax:
Practice Address - Street 1:111 RIVIERA DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2822
Practice Address - Country:US
Practice Address - Phone:410-255-4397
Practice Address - Fax:410-255-4397
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD56461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5646OtherSTATE LICENSE