Provider Demographics
NPI:1891413472
Name:ROCHE, MATTHEW CARY (DMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CARY
Last Name:ROCHE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 GAZEBO DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-8818
Mailing Address - Country:US
Mailing Address - Phone:478-719-1889
Mailing Address - Fax:
Practice Address - Street 1:2900 SEMINARY DR BLDG E
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-3734
Practice Address - Country:US
Practice Address - Phone:724-552-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0423491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics