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General NPI Number Information
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NPI Number | 1306935762
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Entity Type | Individual
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Provider Name | JOHN T ROANE DDS, MS, PHD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6630 CYPRESSWOOD DR STE 175
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City | SPRING
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State | TX
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Zip | 77379-7724
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Country | US
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Telephone | 281-370-1620
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Fax | 281-376-9112
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Provider Business Mailing Address
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Address Line | 6630 CYPRESSWOOD DR STE 175
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City | SPRING
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State | TX
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Zip | 77379-7724
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Country | US
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Telephone | 281-370-1620
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Fax | 281-376-9112
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 8576
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License Number State | TX
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