Provider Demographics
NPI:1760441810
Name:BASORA-ROVIRA, KATYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATYA
Middle Name:
Last Name:BASORA-ROVIRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12120 OLD STAGE TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1713
Mailing Address - Country:US
Mailing Address - Phone:512-839-9722
Mailing Address - Fax:
Practice Address - Street 1:608 GATEWAY CENTRAL STE 201
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-6356
Practice Address - Country:US
Practice Address - Phone:830-693-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX325781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10033OtherCRUZ AZUL
PR41542OtherTRIPLE S
PR9969OtherINTERNATIONAL MEDICAL CAR
PR206760OtherPREFERRED HEALTH
PR26509OtherAMERICAN HEALTH
PR7030022OtherHUMANA