Active NPI
Paul E. Roeh, D.D.S.
- General Practice Dentistry
- Victoria, TX
National Provider Identifier
1790793065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9112
- Practice address
- 109 Professional Park Dr
Victoria, TX 77904-2351 - Phone
- (361) 575-1151
- NPI assigned
- Aug 3, 2006
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9112 | TX | Primary |
Addresses
Primary practice location
109 Professional Park Dr
Victoria, TX 77904-2351
Mailing address
109 Professional Park Dr
Victoria, TX 77904-2351
Phone (361) 575-1151
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B09112-1 | Other | TX | CHILDRENS HEALTH INSURANC |
| 091004401 | Medicaid | TX |
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 |
|---|---|---|---|
| 9112 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225065600000",
"number": "1790793065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 PROFESSIONAL PARK DR",
"city": "VICTORIA",
"state": "TX",
"postal_code": "779042351",
"telephone_number": "361-575-1151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 PROFESSIONAL PARK DR",
"city": "VICTORIA",
"state": "TX",
"postal_code": "779042351",
"telephone_number": "361-575-1151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROEH",
"first_name": "PAUL",
"middle_name": "E.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-03",
"last_updated": "2008-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "9112",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHILDRENS HEALTH INSURANC",
"identifier": "B09112-1",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "091004401",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Victoria, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.