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General NPI Number Information
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NPI Number | 1720694466
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Entity Type | Organization
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Legal Business Name | ROUCHON DENTAL
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 09/18/2020
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Provider Practice Location Address
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Address Line | 3930 KNOWLES AVE STE 302
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City | KENSINGTON
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State | MD
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Zip | 20895-2428
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Country | US
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Telephone | 240-669-4684
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Fax |
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Provider Business Mailing Address
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Address Line | 1810 CALIFORNIA ST NW APT 105
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City | WASHINGTON
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State | DC
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Zip | 20009-1825
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PHILIPPE JOSEPH ROUCHON
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Credential | DDS
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Telephone | 646-596-6443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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