Provider Demographics
NPI:1487722195
Name:VANSANTEN, ROGER (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:VANSANTEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:STAYTON
Mailing Address - State:OR
Mailing Address - Zip Code:97383-0455
Mailing Address - Country:US
Mailing Address - Phone:503-581-7173
Mailing Address - Fax:
Practice Address - Street 1:450 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STAYTON
Practice Address - State:OR
Practice Address - Zip Code:97383-0455
Practice Address - Country:US
Practice Address - Phone:503-769-6351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist