Provider Demographics
NPI:1649378795
Name:ROLAND, JOE (DDS)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:ROLAND
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 1:1650 W IRVING BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7259
Mailing Address - Country:US
Mailing Address - Phone:972-253-5711
Mailing Address - Fax:972-253-0591
Practice Address - Street 1:1650 W IRVING BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7259
Practice Address - Country:US
Practice Address - Phone:972-253-5711
Practice Address - Fax:972-253-0591
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice