Individual
DR. DERRELL JAY ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
14701 SAN PEDRO, STE 250, SAN ANTONIO, TX 78232
(210) 507-9207
Mailing address
14701 SAN PEDRO, SUITE #250, SAN ANTONIO, TX 78232
(210) 507-9207
(210) 491-2039
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
18665
TX
Other
Enumeration date
11/22/2006
Last updated
07/08/2007
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