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General NPI Number Information
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NPI Number | 1427459049
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Entity Type | Organization
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Legal Business Name | BRUCE T. ROACH, D.D.S., P.C.
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 5270 HIGHLAND RD
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City | WATERFORD
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State | MI
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Zip | 48327-1913
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Country | US
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Telephone | 248-673-2400
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Fax | 248-673-8663
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Provider Business Mailing Address
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Address Line | 5270 HIGHLAND RD
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City | WATERFORD
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State | MI
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Zip | 48327-1913
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Country | US
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Telephone | 248-673-2400
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Fax | 248-673-8663
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Authorized Official
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Title or Position | OFFICE COORDINATOR
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Name | MS. LORI ARNOLD
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Credential |
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Telephone | 248-673-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 20149
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12916
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License Number State | MI
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