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General NPI Number Information
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NPI Number | 1760441810
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Entity Type | Individual
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Provider Name | KATYA BASORA-ROVIRA D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/18/2006
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 608 GATEWAY CENTRAL STE 201
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City | MARBLE FALLS
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State | TX
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Zip | 78654-6356
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Country | US
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Telephone | 830-693-7044
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Fax |
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Provider Business Mailing Address
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Address Line | 12120 OLD STAGE TRL
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City | AUSTIN
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State | TX
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Zip | 78750-1713
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Country | US
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Telephone | 512-839-9722
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 32578
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License Number State | TX
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