Healthcare Provider Details

I. General information

NPI: 1740108265
Provider Name (Legal Business Name): KADE DUANE ROACH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GRANDVIEW DR
SALEM IN
47167-1022
US

IV. Provider business mailing address

200 GRANDVIEW DR
SALEM IN
47167-1022
US

V. Phone/Fax

Practice location:
  • Phone: 812-404-1000
  • Fax:
Mailing address:
  • Phone: 812-404-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12015095A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: