Provider Demographics
NPI:1528131919
Name:LAROCQUE, ROBERT J (DDS, MAGD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:LAROCQUE
Suffix:
Gender:M
Credentials:DDS, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 CLAREMONT PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9417
Mailing Address - Country:US
Mailing Address - Phone:603-714-4545
Mailing Address - Fax:
Practice Address - Street 1:4800 LAKEWOOD RANCH BLVD
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4953
Practice Address - Country:US
Practice Address - Phone:941-405-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19371223G0001X
FLDTP6971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice