Active NPI
Cory W Roach, D.D.S.
- Dentist
- Killeen, TX
National Provider Identifier
1295920502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 21755
- Practice address
- 602 E Elms Rd
Killeen, TX 76542-6030 - Phone
- (254) 634-3811
- Fax
- (254) 634-6851
- NPI assigned
- Sep 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 21755 | TX | Primary |
Addresses
Primary practice location
602 E Elms Rd
Killeen, TX 76542-6030
Mailing address
PO Box 10070
Killeen, TX 76547-0070
Phone (254) 634-3811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21755 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Higson & Snyder General Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Killeen, TX
- NPI 1972857126
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189382400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189382400000",
"number": "1295920502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 10070",
"city": "KILLEEN",
"state": "TX",
"postal_code": "765470070",
"telephone_number": "254-634-3811",
"fax_number": "254-634-6851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 E ELMS RD",
"city": "KILLEEN",
"state": "TX",
"postal_code": "765426030",
"telephone_number": "254-634-3811",
"fax_number": "254-634-6851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "CORY",
"middle_name": "W",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-10",
"last_updated": "2007-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "21755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Killeen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 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.