Provider Demographics
NPI:1174649180
Name:ROACH, MAUREEN KATHLEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:KATHLEEN
Last Name:ROACH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 GLENARM PL
Mailing Address - Street 2:#200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-5034
Mailing Address - Country:US
Mailing Address - Phone:303-534-2626
Mailing Address - Fax:303-892-7953
Practice Address - Street 1:1400 GLENARM PL
Practice Address - Street 2:#200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-5034
Practice Address - Country:US
Practice Address - Phone:303-534-2626
Practice Address - Fax:303-892-7953
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice