Provider Demographics
NPI:1497801195
Name:ROUCH, WILLIAM GLEN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GLEN
Last Name:ROUCH
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 1:2300 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-5119
Mailing Address - Country:US
Mailing Address - Phone:812-424-6761
Mailing Address - Fax:812-424-7332
Practice Address - Street 1:2300 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-5119
Practice Address - Country:US
Practice Address - Phone:812-424-6761
Practice Address - Fax:812-424-7332
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist