Provider Demographics
NPI:1184032419
Name:ROTH, NATALIE SIMPSON (DDS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:SIMPSON
Last Name:ROTH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 PALMER PLAZA
Mailing Address - Street 2:103
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758
Mailing Address - Country:US
Mailing Address - Phone:256-772-2626
Mailing Address - Fax:256-772-2602
Practice Address - Street 1:810 PALMER RD STE 103
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3115
Practice Address - Country:US
Practice Address - Phone:256-772-2626
Practice Address - Fax:256-772-2602
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist