Healthcare Provider Details

I. General information

NPI: 1649724782
Provider Name (Legal Business Name): SHANE PATRICK ROCHE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 S CANFIELD NILES RD
YOUNGSTOWN OH
44515-4090
US

IV. Provider business mailing address

290 S CANFIELD NILES RD
YOUNGSTOWN OH
44515-4090
US

V. Phone/Fax

Practice location:
  • Phone: 330-797-0232
  • Fax:
Mailing address:
  • Phone: 330-797-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025225
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: