Provider Demographics
NPI:1538234117
Name:DYERS, ROXANNE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:MARIE
Last Name:DYERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-8229
Mailing Address - Country:US
Mailing Address - Phone:815-521-4292
Mailing Address - Fax:
Practice Address - Street 1:2003 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-8229
Practice Address - Country:US
Practice Address - Phone:815-521-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist