Individual
DR. ELISA MARIE ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28547-2538
(309) 349-2470
Mailing address
115 BLOSSOM CIR, HAMPSTEAD, NC 28443-3281
(309) 349-2470
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.027394
IL
Other
Enumeration date
06/22/2007
Last updated
08/12/2014
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