Provider Demographics
NPI:1134196462
Name:ROEHRICH, MARC ROCHUS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ROCHUS
Last Name:ROEHRICH
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 1:2185 WOODLANE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2916
Mailing Address - Country:US
Mailing Address - Phone:651-731-1560
Mailing Address - Fax:
Practice Address - Street 1:14727 60TH ST N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6323
Practice Address - Country:US
Practice Address - Phone:651-439-9060
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-06
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist