Active NPI
Angie Roach, DDS
- Public Health Dentistry
- Los Fresnos, TX
National Provider Identifier
1447452818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Public Health Dentistry
- License
- 3260
- Practice address
- 27991 Buena Vista Blvd
Los Fresnos, TX 78566-4261 - Phone
- (956) 504-7275
- NPI assigned
- Jun 5, 2007
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Public Health Dentistry | 1223D0001X | 3260 | AR | Primary |
Addresses
Primary practice location
27991 Buena Vista Blvd
Los Fresnos, TX 78566-4261
Mailing address
27991 Buena Vista Blvd
Los Fresnos, TX 78566-4261
Phone (956) 504-7275
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4303260 | Medicaid | OK |
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 |
|---|---|---|---|
| 3260 | AR | MD | Public Health Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372032000000",
"number": "1447452818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27991 BUENA VISTA BLVD",
"city": "LOS FRESNOS",
"state": "TX",
"postal_code": "785664261",
"telephone_number": "956-504-7275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27991 BUENA VISTA BLVD",
"city": "LOS FRESNOS",
"state": "TX",
"postal_code": "785664261",
"telephone_number": "956-504-7275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "ANGIE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-05",
"last_updated": "2013-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223D0001X",
"taxonomy_group": "",
"desc": "Dentist, Dental Public Health",
"state": "AR",
"license": "3260",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4303260",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Fresnos, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.