Individual
DR. CHARLES D ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5775 MAIN STREET, ROCK HALL, MD 21661
(410) 778-1234
Mailing address
5775 MAIN STREET, P.O. BOX 703, ROCK HALL, MD 21661
(410) 778-1234
(410) 778-0232
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9769
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9769
MD STATE DENTAL LICENSE #
MD
Enumeration date
04/26/2007
Last updated
07/08/2007
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