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NPI Code Detail

MEDICARE: KARI SHEREE ROTH RDH

MEDICARE: KARI SHEREE ROTH RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist904897CO

General Provider Information

NPI Number : 1639252232
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARI SHEREE ROTH RDH
Provider Business Mailing Address
First Line : PO BOX 84
Second Line :
City : LAMAR
State : CO
Zip : 81052-0084
Country : US
Telephone Number : 719-336-5857
Fax Number : 719-336-0589
Provider Business Practice Location Address
First Line : 200 KENDALL DR
Second Line :
City : LAMAR
State : CO
Zip : 81052-3940
Country : US
Telephone Number : 719-336-8445
Fax Number : 719-336-0589
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 07/08/2007

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Directions to “ KARI SHEREE ROTH RDH” Practice Location

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