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General NPI Number Information
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NPI Number | 1659113892
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Entity Type | Individual
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Provider Name | KATHARYN ANN ROE-BLYTHE DDS
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Gender | Female
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Dates
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Enumeration Date | 06/10/2024
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 4 W MAIN ST
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City | HERINGTON
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State | KS
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Zip | 67449-2244
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Country | US
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Telephone | 785-258-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 978 S HIGHWAY 4
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City | WHITE CITY
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State | KS
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Zip | 66872-9412
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Country | US
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Telephone | 785-366-6107
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 62139
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 62139
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License Number State | KS
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