Individual
ROBERT E ROESCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
553 N BROAD ST, FREMONT, NE 68025-4930
(402) 727-7331
(402) 727-7675
Mailing address
553 N BROAD ST, FREMONT, NE 68025-4930
(402) 727-7331
(402) 727-7675
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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