Healthcare Provider Details

I. General information

NPI: 1649134958
Provider Name (Legal Business Name): D ROAHEN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13094 NC HIGHWAY 50 STE C
SURF CITY NC
28445-6588
US

IV. Provider business mailing address

13094 NC HIGHWAY 50 STE C
SURF CITY NC
28445-6588
US

V. Phone/Fax

Practice location:
  • Phone: 910-803-0222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DAVID CHARLES ROAHEN
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 410-703-2887