Individual
DR. JUSTIN ROCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11600 W NORTH AVE, WAUWATOSA, WI 53226-2146
(414) 462-3160
Mailing address
15905 W WISCONSIN AVE APT 103, BROOKFIELD, WI 53005-5719
(920) 210-2347
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1002560-15
WI
Other
Enumeration date
04/09/2021
Last updated
08/28/2023
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