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General NPI Number Information
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NPI Number | 1871334573
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Entity Type | Individual
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Provider Name | KATHERINE ANDERSON ROTH DMD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 306 FOUNTAINS DR
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City | MADISON
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State | MS
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Zip | 39110-6384
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Country | US
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Telephone | 601-605-1410
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Fax |
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Provider Business Mailing Address
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Address Line | 3117 W TIDEWATER LN
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City | MADISON
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State | MS
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Zip | 39110-8928
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Country | US
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Telephone | 662-202-7377
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4459-24
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License Number State | MS
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