Provider Demographics
NPI:1740595545
Name:ROUCHON, PHILIPPE JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIPPE
Middle Name:JOSEPH
Last Name:ROUCHON
Suffix:
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 1:1810 CALIFORNIA ST NW APT 105
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-1825
Mailing Address - Country:US
Mailing Address - Phone:646-596-6443
Mailing Address - Fax:
Practice Address - Street 1:3930 KNOWLES AVE STE 302
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2428
Practice Address - Country:US
Practice Address - Phone:240-669-4684
Practice Address - Fax:240-669-4686
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055188122300000X
MD16141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist