Provider Demographics
NPI:1568470391
Name:KARP, ROGER S (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:S
Last Name:KARP
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6835 BROADWAY AVE
Mailing Address - Street 2:METROHEALTH BROADWAY HEALTH CENTER
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-1313
Mailing Address - Country:US
Mailing Address - Phone:216-957-4090
Mailing Address - Fax:
Practice Address - Street 1:6835 BROADWAY AVE
Practice Address - Street 2:METROHEALTH BROADWAY HEALTH CENTER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-1313
Practice Address - Country:US
Practice Address - Phone:216-957-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300160771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0398127Medicaid
OHKA0757091Medicare ID - Type Unspecified
OH0398127Medicaid