1003025107 NPI number — ROGER ALAN DAHLSEID D.D.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003025107 NPI number — ROGER ALAN DAHLSEID D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAHLSEID
Provider First Name:
ROGER
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003025107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 208
Provider Second Line Business Mailing Address:
CIBEQUE CIRCLE
Provider Business Mailing Address City Name:
SAN CARLOS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85550-0208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-475-7354
Provider Business Mailing Address Fax Number:
928-475-7380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 CIBEQUE CIRCLE
Provider Second Line Business Practice Location Address:
CIBEQUE CIRCLE
Provider Business Practice Location Address City Name:
SAN CARLOS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85550-0208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-475-7354
Provider Business Practice Location Address Fax Number:
928-475-7380
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2180 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com