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NPI Code Detail

MEDICARE: DR. JASON A ROTH DDS

MEDICARE:  DR. JASON A ROTH  DDS
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
1122300000XDentist52922CA

General Provider Information

NPI Number : 1841380920
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON A ROTH DDS
Provider Business Mailing Address
First Line : PO BOX 5465
Second Line :
City : EL DORADO HILLS
State : CA
Zip : 95762-0009
Country : US
Telephone Number : 916-213-4255
Fax Number :
Provider Business Practice Location Address
First Line : 4517 SERRANO PARKWAY
Second Line : SUITE 101
City : EL DORADO HILLS
State : CA
Zip : 95762
Country : US
Telephone Number : 916-939-9999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2006
Last Update Date : 09/04/2012

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Directions to “ DR. JASON A ROTH DDS” Practice Location

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