1093903676 NPI number — ROGER ANTONIO SAENZ DDS

Table of content: ROGER ANTONIO SAENZ DDS (NPI 1093903676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093903676 NPI number — ROGER ANTONIO SAENZ DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAENZ
Provider First Name:
ROGER
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1093903676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9743 NW 30TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORAL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33172-1081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-898-9228
Provider Business Mailing Address Fax Number:
305-885-7682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
752 W 29TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012-5606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-885-9786
Provider Business Practice Location Address Fax Number:
305-885-7682
Provider Enumeration Date:
10/09/2007

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: 122300000X , with the licence number:  DN14217 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 113335200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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