Provider Demographics
NPI:1427175751
Name:HITCHCOCK, ROGER P (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:P
Last Name:HITCHCOCK
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:2058 S STATE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4786
Mailing Address - Country:US
Mailing Address - Phone:734-769-5302
Mailing Address - Fax:734-769-6743
Practice Address - Street 1:2058 S STATE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4786
Practice Address - Country:US
Practice Address - Phone:734-769-5302
Practice Address - Fax:734-769-6743
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology