Provider Demographics
NPI:1174564868
Name:ST. ONGE, ROLAND JOSEPH JR
Entity type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:JOSEPH
Last Name:ST. ONGE
Suffix:JR
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 1:363 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03276-5010
Mailing Address - Country:US
Mailing Address - Phone:603-286-3032
Mailing Address - Fax:603-286-8445
Practice Address - Street 1:363 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TILTON
Practice Address - State:NH
Practice Address - Zip Code:03276-5010
Practice Address - Country:US
Practice Address - Phone:603-286-3032
Practice Address - Fax:603-286-8445
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist