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General NPI Number Information
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NPI Number | 1194419986
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Entity Type | Individual
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Provider Name | PATRICK CHARLES ROESCH DDS
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Gender | Male
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Dates
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Enumeration Date | 06/06/2023
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Last Update Date | 06/06/2023
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Provider Practice Location Address
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Address Line | 117 HECTOR CONNOLY RD STE 2
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City | CARENCRO
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State | LA
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Zip | 70520
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Country | US
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Telephone | 337-565-2580
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Fax |
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Provider Business Mailing Address
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Address Line | 112 FRANCOIS DR
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City | LAFAYETTE
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State | LA
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Zip | 70507-9735
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Country | US
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Telephone | 337-501-7964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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