Individual
DR. ROGER J FORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS,MS
Contact information
Practice address
1840 FOLSOM ST, SUITE 302, BOULDER, CO 80302-5712
(303) 938-8300
(303) 441-5811
Mailing address
1840 FOLSOM ST, SUITE 302, BOULDER, CO 80302-5712
(303) 938-8300
(303) 441-5811
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0053
CO
Other
Enumeration date
11/07/2006
Last updated
07/08/2007
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