Provider Demographics
NPI:1376670059
Name:ROBERTSON, KARLA WELCH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:WELCH
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-0390
Mailing Address - Country:US
Mailing Address - Phone:318-428-4255
Mailing Address - Fax:318-428-5900
Practice Address - Street 1:414 ROSS ST.
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263
Practice Address - Country:US
Practice Address - Phone:318-428-4255
Practice Address - Fax:318-428-5900
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist