Individual
HEIDI M. ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
S2845 WHITE EAGLE RD, BARABOO, WI 53913-9064
(608) 355-1240
Mailing address
W8595 BILKIE RD, POYNETTE, WI 53955-9774
(608) 635-7663
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
4219-016
WI
Other
Enumeration date
02/07/2007
Last updated
07/08/2007
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