Provider Demographics
NPI:1851485395
Name:ROUCH, BARRY F (DDS, MS)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:F
Last Name:ROUCH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11410 JOLLYVILLE ROAD, SUITE 2102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4093
Mailing Address - Country:US
Mailing Address - Phone:512-338-1118
Mailing Address - Fax:512-338-1332
Practice Address - Street 1:11410 JOLLYVILLE RD, SUITE 2102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4093
Practice Address - Country:US
Practice Address - Phone:512-338-1118
Practice Address - Fax:512-338-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics