Provider Demographics
NPI:1588787873
Name:PIKE, ROGER KEITH (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:KEITH
Last Name:PIKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 S MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-8811
Mailing Address - Country:US
Mailing Address - Phone:812-934-6447
Mailing Address - Fax:
Practice Address - Street 1:200 CROSS COUNTY PLZ # A
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-8914
Practice Address - Country:US
Practice Address - Phone:812-934-3838
Practice Address - Fax:812-934-5985
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009140A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist