Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | LA |
NPI | 1104431162 |
---|---|
Provider Name | Karyn Roges |
First Address | Baton Rouge, LA 70805-2643 |
Second Address | Baton Rouge, LA 70805-2643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2020 |
Last Update Date | 15/09/2020 |