MEDICARE: DR. JOSE ROQUE JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	61053	KS
2	1223G0001X	General Practice Dentistry	DN21267	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093111767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE ROQUE JR. DDS

Provider Business Mailing Address
First Line	:	4280 BEE RIDGE RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-2563
Country	:	US
Telephone Number	:	941-363-6381
Fax Number	:

Provider Business Practice Location Address
First Line	:	4280 BEE RIDGE RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34233-2563
Country	:	US
Telephone Number	:	941-363-6381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2014
Last Update Date	:	04/27/2018

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