Provider Demographics
NPI:1649305301
Name:FIELDMAN, ROGER PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PAUL
Last Name:FIELDMAN
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 1:130 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2238
Mailing Address - Country:US
Mailing Address - Phone:213-484-9660
Mailing Address - Fax:213-484-8317
Practice Address - Street 1:130 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2238
Practice Address - Country:US
Practice Address - Phone:213-484-9660
Practice Address - Fax:213-484-8317
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice