Provider Demographics
NPI:1316148224
Name:LIVINGOOD, ROGER DAYTON (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DAYTON
Last Name:LIVINGOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4122 E SAN MIGUEL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1140
Mailing Address - Country:US
Mailing Address - Phone:602-840-5042
Mailing Address - Fax:602-840-5042
Practice Address - Street 1:13575 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4901
Practice Address - Country:US
Practice Address - Phone:623-935-9873
Practice Address - Fax:623-536-6700
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZD49251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry