Provider Demographics
NPI:1174650527
Name:ROLLE, RICHARD R JR (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:ROLLE
Suffix:JR
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 1:229 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8543
Mailing Address - Country:US
Mailing Address - Phone:704-799-0771
Mailing Address - Fax:704-799-2941
Practice Address - Street 1:9615 CALDWELL COMMONS CIR
Practice Address - Street 2:SUITE B
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8187
Practice Address - Country:US
Practice Address - Phone:704-892-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAD-8950204E00000X
NC94061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery