| NPI | 1447875125 |
|---|---|
| Former Name | KATIE NICOLE ROSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL D-0006833-C1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 7084) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2022-05-31 |