Provider Demographics
NPI:1386602852
Name:FIEDLER, ROGER SCOTT
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:SCOTT
Last Name:FIEDLER
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ROGER
Other - Middle Name:SCOTT
Other - Last Name:FIEDLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:USA DENTAC BAVARIA
Mailing Address - Street 2:UNIT 28038
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:314-476-4738
Mailing Address - Fax:314-476-4738
Practice Address - Street 1:USA DENTAC BAVARIA
Practice Address - Street 2:UNIT 28038
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:314-476-4738
Practice Address - Fax:314-476-4738
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025883L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice