Provider Demographics
NPI:1194419986
Name:ROESCH, PATRICK CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:CHARLES
Last Name:ROESCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FRANCOIS DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-9735
Mailing Address - Country:US
Mailing Address - Phone:337-501-7964
Mailing Address - Fax:
Practice Address - Street 1:117 HECTOR CONNOLY RD STE 2
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520
Practice Address - Country:US
Practice Address - Phone:337-565-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program