=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245558089
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARLA H ROHER, D.M.D, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2010
-----------------------------------------------------
Last Update Date | 05/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28 MEDICAL ARTS CTR 836 EAST 65TH STREET
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31405-4415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-355-0605
-----------------------------------------------------
Fax | 912-355-0659
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28 MEDICAL ARTS CTR 836 EAST 36TH STREET
-----------------------------------------------------
City | SAVANNAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31405-4415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-335-0605
-----------------------------------------------------
Fax | 912-355-0659
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. CARLA H ROHER
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 912-355-0605
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN013354
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------