Provider Demographics
NPI:1487958641
Name:DAVID ROACH DDS FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:DAVID ROACH DDS FAMILY DENTISTRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-383-7801
Mailing Address - Street 1:3817 BEDFORD AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2546
Mailing Address - Country:US
Mailing Address - Phone:615-383-7801
Mailing Address - Fax:615-297-2834
Practice Address - Street 1:3817 BEDFORD AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2546
Practice Address - Country:US
Practice Address - Phone:615-383-7801
Practice Address - Fax:615-297-2834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty