Provider Demographics
NPI:1003036617
Name:ROUGHLEY, ROBERT LLOYD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LLOYD
Last Name:ROUGHLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 N TENAYA WAY
Mailing Address - Street 2:SUITTE 206
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0456
Mailing Address - Country:US
Mailing Address - Phone:702-240-6370
Mailing Address - Fax:702-240-6373
Practice Address - Street 1:2931 N TENAYA WAY
Practice Address - Street 2:SUITTE 206
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0456
Practice Address - Country:US
Practice Address - Phone:702-240-6370
Practice Address - Fax:702-240-6373
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist