Provider Demographics
NPI:1679889950
Name:SAENZ, ROGER J
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:J
Last Name:SAENZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5606
Mailing Address - Country:US
Mailing Address - Phone:305-885-9786
Mailing Address - Fax:905-885-7682
Practice Address - Street 1:752 W 29TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5606
Practice Address - Country:US
Practice Address - Phone:305-885-9786
Practice Address - Fax:305-885-7682
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL119091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice