Organization
RIVERSIDE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOUIS R ROQUE D.D.S. (DENTIST)
(772) 589-1140
Entity
Organization
Contact information
Practice address
9402 N US HIGHWAY 1, SEBASTIAN, FL 32958-6398
(772) 589-1140
Mailing address
9402 N US HIGHWAY 1, SEBASTIAN, FL 32958-6398
(772) 589-1140
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN 12242
FL
Other
Enumeration date
09/13/2007
Last updated
09/13/2007
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