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General NPI Number Information
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NPI Number | 1740595545
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Entity Type | Individual
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Provider Name | PHILIPPE JOSEPH ROUCHON DDS
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Gender | Male
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Dates
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Enumeration Date | 08/17/2010
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Last Update Date | 12/11/2020
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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 | 240-669-4686
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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 | 646-596-6443
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 055188
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16141
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License Number State | MD
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