Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 849 | NV |
NPI | 1003036617 |
---|---|
Provider Name | Dr. Robert Lloyd Roughley |
First Address | Las Vegas, NV 89128-0456 |
Second Address | Las Vegas, NV 89128-0456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |