Individual
NICOLE ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
423 E LOGAN ST, MOBERLY, MO 65270-2222
(660) 263-6643
(660) 263-0333
Mailing address
423 E LOGAN ST, MOBERLY, MO 65270-0488
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2007015370
MO
Other
Enumeration date
06/17/2011
Last updated
06/17/2011
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