Individual
KAYLA MARIE ROE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6605 W BROAD ST STE 105, RICHMOND, VA 23230-1714
(804) 495-2631
Mailing address
875 N MILWAUKEE AVE UNIT 2-3E, CHICAGO, IL 60642-4188
(804) 840-7170
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401416761
VA
Other
Enumeration date
07/12/2018
Last updated
07/08/2020
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