Individual
MESA ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1006 A ST, GREELEY, CO 80631-2021
(970) 352-0048
(970) 352-1120
Mailing address
2930 11TH AVE, EVANS, CO 80620-1011
(970) 353-9403
(970) 353-9906
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9286
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11379766
—
CO
Enumeration date
05/29/2007
Last updated
06/03/2014
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