Provider Demographics
NPI:1497422182
Name:BARRY F. ROUCH, DDS, MS, PLLC
Entity Type:Organization
Organization Name:BARRY F. ROUCH, DDS, MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:512-338-1118
Mailing Address - Street 1:11410 JOLLYVILLE RD STE 2102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4013
Mailing Address - Country:US
Mailing Address - Phone:512-338-1118
Mailing Address - Fax:
Practice Address - Street 1:11410 JOLLYVILLE RD STE 2102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4013
Practice Address - Country:US
Practice Address - Phone:512-338-1118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty