Individual
DR. SUSAN ROCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
11092 ANDERSON STREET, LOMA LINDA, CA 92354
(909) 558-4613
Mailing address
11092 ANDERSON STREET, LOMA LINDA, CA 92354
(909) 558-4613
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
41530
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41530
STATE LICENSE NUMBER
CA
Enumeration date
05/17/2007
Last updated
07/08/2007
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