Healthcare Provider Details

I. General information

NPI: 1023197019
Provider Name (Legal Business Name): DAVID H. ROHOLT, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MIKKELSEN DR.
AUBURN CA
95603
US

IV. Provider business mailing address

635 MIKKELSEN DR.
AUBURN CA
95603
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-5696
  • Fax: 530-885-5698
Mailing address:
  • Phone: 530-885-5696
  • Fax: 530-885-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37600
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID H ROHOLT
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 530-885-5696