Healthcare Provider Details

I. General information

NPI: 1285685594
Provider Name (Legal Business Name): DAVID CHRISTIAN ROTH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 W 10400 S SUITE 103
SOUTH JORDAN UT
84095-8953
US

IV. Provider business mailing address

2651 W 10400 S SUITE 103
SOUTH JORDAN UT
84095-8953
US

V. Phone/Fax

Practice location:
  • Phone: 801-446-1515
  • Fax: 801-446-5290
Mailing address:
  • Phone: 801-446-1515
  • Fax: 801-446-5290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number343291
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: