Provider Demographics
NPI:1942429931
Name:DE LA ROCHE, BEATRIZ (DMD)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:DE LA ROCHE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6583 ROUTE 819 S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-3503
Mailing Address - Country:US
Mailing Address - Phone:724-542-4818
Mailing Address - Fax:724-542-4828
Practice Address - Street 1:6583 ROUTE 819 S
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-3503
Practice Address - Country:US
Practice Address - Phone:724-542-4818
Practice Address - Fax:724-542-4828
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030164L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000271462OtherUNITED CONCORDIA
PA000000191199Medicaid
PA2443009OtherAETNA DENTAL