Individual
DR. ROGER J. ROTH
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1801 N 3RD ST, COEUR D ALENE, ID 83814-3400
(208) 667-1578
(208) 765-9116
Mailing address
1801 N 3RD ST, COEUR D ALENE, ID 83814-3400
(208) 667-1578
(208) 765-9116
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD1443
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4084
BLUE CROSS
ID
01
—
7170
WDS
WA
Enumeration date
06/21/2005
Last updated
07/08/2007
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