Organization
EDGAR D. ROQUE, D.D.S.,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDGAR ROQUE (DENTIST/PRESIDENT)
(559) 412-4702
Entity
Organization
Contact information
Practice address
420 W. SHIELDS AVE, FRESNO, CA 93705-4107
(559) 412-4702
(559) 473-1475
Mailing address
420 W. SHIELDS AVE, FRESNO, CA 93705-4107
(559) 412-4702
(559) 473-1475
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
55681
CA
Other
Enumeration date
11/30/2010
Last updated
02/15/2011
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