Provider Demographics
NPI:1063685576
Name:ROTH, GILBERT R (DMD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:R
Last Name:ROTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 WATERDAM RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317
Mailing Address - Country:US
Mailing Address - Phone:724-942-3820
Mailing Address - Fax:724-942-5810
Practice Address - Street 1:161 WATERDAM RD
Practice Address - Street 2:SUITE 250
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317
Practice Address - Country:US
Practice Address - Phone:724-942-3820
Practice Address - Fax:724-942-5810
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017184L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist