Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 4539 | WA |
N | 213EG0000X | General Practice | 4539 | WA |
N | 1223G0001X | General Practice | 7107 | WA |
N | 213EG0000X | General Practice | 7107 | WA |
N | 1223G0001X | General Practice | 9791 | WA |
N | 213EG0000X | General Practice | 9791 | WA |
N | 124Q00000X | Dental Hygienist | 2969 | WA |
N | 124Q00000X | Dental Hygienist | 4236 | WA |
N | 124Q00000X | Dental Hygienist | 5419 | WA |
N | 124Q00000X | Dental Hygienist | 5766 | WA |
N | 124Q00000X | Dental Hygienist | 6008 | WA |
N | 124Q00000X | Dental Hygienist | 7057 | WA |
NPI | 1043317449 |
---|---|
Provider Name | Karl David Rose |
First Address | Battle Ground, WA 98604-0157 |
Second Address | Battle Ground, WA 98604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |