Matthew Christian Roach, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10277 Issued in SC

Practice address

271 Fort Richardson Ave
Goodfellow Afb, TX 76908-4901

Phone

(325) 654-3050

NPI assigned

Dec 2, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1669939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722297600000",
    "number": "1518677277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SOMERLEAF WAY",
            "city": "SIMPSONVILLE",
            "state": "SC",
            "postal_code": "296815153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 FORT RICHARDSON AVE",
            "city": "GOODFELLOW AFB",
            "state": "TX",
            "postal_code": "769084901",
            "telephone_number": "325-654-3050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "92 Nealy Blvd",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "236652022",
            "country_code": "US",
            "telephone_number": "757-225-8278",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROACH",
        "first_name": "MATTHEW",
        "middle_name": "CHRISTIAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-12-02",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "10277",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Elizabeth Peters, OD
• Stacy Poindexter, PHARMD
• Robert Wesley Rainey, PHARM. D.
• Micah Rejcek, DO
• Natalie Lynn Restivo, M.D.
• Elaine Nicole Sexton, RN
• William C Shelby, PA-C
• Samantha Slikkers, DDS
• Teresa Marie Stanley, PA
• Robert Wayne Turner, LCSW

• General Practice Dentistry in Goodfellow Afb, TX
• Providers in Goodfellow Afb, 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 30, 2024; 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.