=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700901691
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL J. ROTH,D.M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 LIVINGSTON ST
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07648-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-784-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 LIVINGSTON ST
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07648-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PAUL JOSEPH ROTH
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 201-784-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DI11804
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------