Individual
STEPHEN C ROEHM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
5006 N UNIVERSITY ST, PEORIA, IL 61614-4715
(309) 691-9665
(309) 691-9680
Mailing address
5006 N UNIVERSITY ST, PEORIA, IL 61614-4715
(309) 691-9665
(309) 691-9680
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
1915903
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1004551
—
IL
Enumeration date
10/21/2008
Last updated
10/21/2008
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