Healthcare Provider Details

I. General information

NPI: 1427233212
Provider Name (Legal Business Name): WILLIAM C ROTH DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 HOLLOW BROOK DRIVE #200
COLORADO SPRINGS CO
80918
US

IV. Provider business mailing address

2116 HOLLOW BROOK DRIVE #200
COLORADO SPRINGS CO
80918
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-0038
  • Fax: 719-597-6239
Mailing address:
  • Phone: 719-597-0038
  • Fax: 719-597-6239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8936
License Number StateCO

VIII. Authorized Official

Name: MRS. RENEE A PENNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 719-597-0038