Provider Demographics
NPI:1497145817
Name:ROACH, RHONDA JOCELYN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:JOCELYN
Last Name:ROACH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12454 GWEN DR UNIT 20
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3831
Mailing Address - Country:US
Mailing Address - Phone:360-941-0906
Mailing Address - Fax:
Practice Address - Street 1:12454 GWEN DR UNIT 20
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-3831
Practice Address - Country:US
Practice Address - Phone:360-941-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-24
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006649124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist