Individual
MARIA ROQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
220 E COMMERCE CT STE A, ELKHORN, WI 53121-4371
(262) 723-3224
Mailing address
1105 S 32ND ST, MILWAUKEE, WI 53215-1553
(143) 646-5304
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6001426-15
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/11/2023
Last updated
04/28/2025
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