Individual
DR. BRANDI RACHELLE ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S
Contact information
Practice address
2707 W HUNTSVILLE AVE, SPRINGDALE, AR 72762-7723
(479) 756-8631
(479) 751-7892
Mailing address
2707 W HUNTSVILLE AVE, SPRINGDALE, AR 72762-7723
(479) 756-8631
(479) 751-7892
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3363
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1317596
—
AR
01
—
3363
DELTA
AR
01
—
58250
BCBS
AR
Enumeration date
10/27/2006
Last updated
07/08/2007
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