Provider Demographics
NPI:1104070770
Name:PINT, ROGER JACOB JR (DMD MPH)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JACOB
Last Name:PINT
Suffix:JR
Gender:M
Credentials:DMD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 BONITA BEACH RD SE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4280
Mailing Address - Country:US
Mailing Address - Phone:239-676-8730
Mailing Address - Fax:
Practice Address - Street 1:9200 BONITA BEACH RD SE
Practice Address - Street 2:SUITE 111
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4280
Practice Address - Country:US
Practice Address - Phone:239-676-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 189081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice