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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