Provider Demographics
NPI:1952747719
Name:ROBERTS, KATIE COURVILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:COURVILLE
Last Name:ROBERTS
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 1:3632 COMMON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70607-1744
Mailing Address - Country:US
Mailing Address - Phone:337-478-4022
Mailing Address - Fax:337-478-4017
Practice Address - Street 1:3632 COMMON ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-1744
Practice Address - Country:US
Practice Address - Phone:337-478-4022
Practice Address - Fax:337-478-4017
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA63511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice