Healthcare Provider Details

I. General information

NPI: 1770260622
Provider Name (Legal Business Name): DEVON ROESE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 TOWN CENTER BLVD STE 202
CRESTVIEW HILLS KY
41017-2417
US

IV. Provider business mailing address

4787 HOUSTON RD APT 1301
FLORENCE KY
41042-4809
US

V. Phone/Fax

Practice location:
  • Phone: 859-344-6200
  • Fax:
Mailing address:
  • Phone: 812-374-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11201
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30.028370
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: