Healthcare Provider Details

I. General information

NPI: 1568470391
Provider Name (Legal Business Name): ROGER S KARP DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6835 BROADWAY AVE METROHEALTH BROADWAY HEALTH CENTER
CLEVELAND OH
44105-1313
US

IV. Provider business mailing address

6835 BROADWAY AVE METROHEALTH BROADWAY HEALTH CENTER
CLEVELAND OH
44105-1313
US

V. Phone/Fax

Practice location:
  • Phone: 216-957-4090
  • Fax:
Mailing address:
  • Phone: 216-957-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number30016077
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: