Healthcare Provider Details

I. General information

NPI: 1740371616
Provider Name (Legal Business Name): KYLE ROTH AND ASSOCIATES VI, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 WAYNE MEMORIAL DR STE C
GOLDSBORO NC
27534-2269
US

IV. Provider business mailing address

1310 WAYNE MEMORIAL DR STE C
GOLDSBORO NC
27534-2269
US

V. Phone/Fax

Practice location:
  • Phone: 919-581-0909
  • Fax: 919-581-0730
Mailing address:
  • Phone: 919-581-0909
  • Fax: 919-581-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MEGAN PRIDGEN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 919-696-6394