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Organization
MARY K. ROTH D.D.S. PC
Active
Organization
MARY K. ROTH D.D.S. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY KAY ROTH D.D.S. (DOCTER)
(605) 343-9352
Entity
Organization
Contact information
Practice address
807 SAINT ANDREW ST, RAPID CITY, SD 57701-4526
(605) 343-9352
(605) 343-3115
Mailing address
807 SAINT ANDREW ST, RAPID CITY, SD 57701-4526
(605) 343-9352
(605) 343-3115
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
M697
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7805870
—
SD
01
—
BR1122302
OTHER
SD
Enumeration date
05/31/2007
Last updated
06/10/2008
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