Provider Demographics
NPI:1679895452
Name:ROGER A. BRIGGS, D.D.S. LTD
Entity type:Organization
Organization Name:ROGER A. BRIGGS, D.D.S. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-948-7670
Mailing Address - Street 1:6920 E. SHEA BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:SCOTTSDALE,
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-7100
Mailing Address - Country:US
Mailing Address - Phone:480-948-7670
Mailing Address - Fax:480-991-7168
Practice Address - Street 1:6920 E. SHEA BLVD
Practice Address - Street 2:STE 201
Practice Address - City:SCOTTSDALE,
Practice Address - State:AZ
Practice Address - Zip Code:85254-7100
Practice Address - Country:US
Practice Address - Phone:480-948-7670
Practice Address - Fax:480-991-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD18721223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6341140001Medicare NSC