Provider Demographics
NPI:1225662687
Name:ROTH, ASHLEY RAYE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:RAYE
Last Name:ROTH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:RAYE
Other - Last Name:ROTH-GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1170 E MEGHANS RD
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-6525
Mailing Address - Country:US
Mailing Address - Phone:928-451-2056
Mailing Address - Fax:
Practice Address - Street 1:4175 S ALAMO AVE BLDG 400
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707
Practice Address - Country:US
Practice Address - Phone:520-228-1907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD0108361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program