Provider Demographics
NPI:1952477580
Name:ROCHE FAMILY DENTISTRY PA
Entity Type:Organization
Organization Name:ROCHE FAMILY DENTISTRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CARVER
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:936-291-3455
Mailing Address - Street 1:1117 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340
Mailing Address - Country:US
Mailing Address - Phone:936-291-3455
Mailing Address - Fax:936-293-1922
Practice Address - Street 1:1117 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-291-3455
Practice Address - Fax:936-293-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty