Provider Demographics
NPI:1952473068
Name:WEST, ROGER JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JOHN
Last Name:WEST
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 1:320 W MCLANE
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50213-1511
Mailing Address - Country:US
Mailing Address - Phone:641-342-6648
Mailing Address - Fax:
Practice Address - Street 1:320 W MCLANE
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1511
Practice Address - Country:US
Practice Address - Phone:641-342-6648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0204792Medicaid
IA204792OtherDELTA DENTAL