Individual
CLYDE ROGGENKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
11092 ANDERSON ST, LOMA LINDA, CA 92350-1706
(909) 558-4603
Mailing address
11092 ANDERSON ST, LOMA LINDA, CA 92350-1706
(909) 558-4603
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
54358
CA
Other
Enumeration date
09/06/2016
Last updated
09/06/2016
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