Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | DE60610007 | WA |
Y | 1223P0300X | Periodontist | DS041836 | PA |
NPI | 1114391687 |
---|---|
Provider Name | Dr. Katherine L Roll |
First Address | Mc Kees Rocks, PA 15136-4305 |
Second Address | Mc Kees Rocks, PA 15136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2015 |
Last Update Date | 18/07/2018 |