Individual
PHILIP C ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2121 E DUPONT RD, SUITE B, FORT WAYNE, IN 46825-1546
(260) 489-1818
(260) 490-1705
Mailing address
2121 E DUPONT RD, SUITE B, FORT WAYNE, IN 46825-1546
(260) 489-1818
(260) 490-1705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008612A
IN
Other
Enumeration date
03/07/2007
Last updated
10/09/2007
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