Basic Information
| Provider Information | |||||||||
| NPI: | 1316148224 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIVINGOOD | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | DAYTON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4122 E SAN MIGUEL AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850181140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028405042 | ||||||||
| FaxNumber: | 6028405042 | ||||||||
| Practice Location | |||||||||
| Address1: | 13575 W INDIAN SCHOOL RD | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | LITCHFIELD PARK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853404901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239359873 | ||||||||
| FaxNumber: | 6235366700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | D4925 | AZ | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.