Provider Demographics
NPI:1659113892
Name:ROE-BLYTHE, KATHARYN ANN (DDS)
Entity type:Individual
Prefix:
First Name:KATHARYN
Middle Name:ANN
Last Name:ROE-BLYTHE
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 1:978 S HIGHWAY 4
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66872-9412
Mailing Address - Country:US
Mailing Address - Phone:785-366-6107
Mailing Address - Fax:
Practice Address - Street 1:4 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HERINGTON
Practice Address - State:KS
Practice Address - Zip Code:67449-2244
Practice Address - Country:US
Practice Address - Phone:785-258-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS621391223D0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health