Active NPI
Clyde Roggenkamp, D.D.S.
- Dentist
- Loma Linda, CA
National Provider Identifier
1992252084
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 54358
- Practice address
- 11092 Anderson St
Loma Linda, CA 92350-1706 - Phone
- (909) 558-4603
- NPI assigned
- Sep 6, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 54358 | CA | Primary |
Addresses
Primary practice location
11092 Anderson St
Loma Linda, CA 92350-1706
Mailing address
11092 Anderson St
Loma Linda, CA 92350-1706
Phone (909) 558-4603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54358 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473120000000",
"number": "1992252084",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11092 ANDERSON ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923501706",
"telephone_number": "909-558-4603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11092 ANDERSON ST",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923501706",
"telephone_number": "909-558-4603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROGGENKAMP",
"first_name": "CLYDE",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-09-06",
"last_updated": "2016-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "54358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.