Provider Demographics
NPI:1083992184
Name:GAUSE, ROGER A (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:GAUSE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E 58TH ST STE 1201
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1269
Mailing Address - Country:US
Mailing Address - Phone:917-675-7468
Mailing Address - Fax:212-588-8841
Practice Address - Street 1:133 E 58TH ST STE 1201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1269
Practice Address - Country:US
Practice Address - Phone:917-675-7468
Practice Address - Fax:212-588-8841
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500555641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice