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Individual
ROBERT E ROESCH
Active
Individual
ROBERT E ROESCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4720
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
470687190
TAX IDENTIFIER NUMBER
—
05
—
47068719000
—
NE
01
—
4720
STATE DENTAL LICENSE NUMB
NE
Enumeration date
07/27/2006
Last updated
04/21/2016
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