Healthcare Provider Details

I. General information

NPI: 1962694141
Provider Name (Legal Business Name): LAUREEN M ROH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 S HARBOR BLVD STE 5
LAHABRA CA
90631
US

IV. Provider business mailing address

1480 S HARBOR BLVD STE 5
LAHABRA CA
90631
US

V. Phone/Fax

Practice location:
  • Phone: 714-870-5200
  • Fax: 714-870-5481
Mailing address:
  • Phone: 714-870-5200
  • Fax: 714-870-5481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number40301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: