Provider Demographics
NPI:1982733838
Name:BISSON, ROGER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:BISSON
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 1:2 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9767
Mailing Address - Country:US
Mailing Address - Phone:406-443-5130
Mailing Address - Fax:
Practice Address - Street 1:2 MARKET ST
Practice Address - Street 2:
Practice Address - City:CLANCY
Practice Address - State:MT
Practice Address - Zip Code:59634-9767
Practice Address - Country:US
Practice Address - Phone:406-443-5130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist