Bruce Dee Roach, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13219 Issued in TX

Practice address

11672 Jollyville Rd
Austin, TX 78759-3935

Phone

(512) 918-0005

Fax

(512) 918-0008

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jollyville Dental Professionals

  • General Practice Dentistry
  • Austin, TX
  • NPI 1417155417
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184112000000",
    "number": "1225056690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11672 JOLLYVILLE RD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787593935",
            "telephone_number": "512-918-0005",
            "fax_number": "512-918-0008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11672 JOLLYVILLE RD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787593935",
            "telephone_number": "512-918-0005",
            "fax_number": "512-918-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "BRUCE",
        "middle_name": "DEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "13219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• RMG Physical Therapy
• Rmka Inc
• RN Poonawala PA
• RNG Therapy LLC
• Leticia Roa Guerrero
• Paul Jeffrey Roach, M.D.
• Sherrie Roach, R.PH.
• Terra D Roarabaugh, APRN
• Tom Rimbert Roark, M.D.
• Mandi Roarke

• General Practice Dentistry in Austin, TX
• Providers in Austin, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.