Healthcare Provider Details

I. General information

NPI: 1114391687
Provider Name (Legal Business Name): KATHERINE L ROLL DMD, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2015
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 STEUBENVILLE PIKE STE 201
MC KEES ROCKS PA
15136
US

IV. Provider business mailing address

6200 STEUBENVILLE PIKE STE 201
MC KEES ROCKS PA
15136-4305
US

V. Phone/Fax

Practice location:
  • Phone: 412-888-0097
  • Fax: 412-788-8590
Mailing address:
  • Phone: 412-888-0097
  • Fax: 412-788-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE60610007
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS041836
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: