Healthcare Provider Details

I. General information

NPI: 1699756502
Provider Name (Legal Business Name): CHRISTIAN F ROULEAU DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 GEORGE BUSH BLVD
DELRAY BEACH FL
33444-4063
US

IV. Provider business mailing address

167 YACHT CLUB WAY APT 108
HYPOLUXO FL
33462-6061
US

V. Phone/Fax

Practice location:
  • Phone: 561-278-2388
  • Fax: 561-278-0721
Mailing address:
  • Phone: 561-313-8161
  • Fax: 561-278-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7406
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number18541
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: