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General NPI Number Information
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NPI Number | 1982096897
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Entity Type | Organization
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Legal Business Name | RONALD R. ROTT
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 4145 GARDEN HWY
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City | SACRAMENTO
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State | CA
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Zip | 95834-9600
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Country | US
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Telephone | 916-835-3504
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Fax |
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Provider Business Mailing Address
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Address Line | 4145 GARDEN HWY
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City | SACRAMENTO
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State | CA
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Zip | 95834-9600
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Country | US
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Telephone | 915-835-3504
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONALD R ROTT
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Credential |
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Telephone | 916-835-3504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 17545
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License Number State | CA
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