Provider Demographics
NPI:1285685594
Name:ROTH, DAVID CHRISTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTIAN
Last Name:ROTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2651 W 10400 S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8953
Mailing Address - Country:US
Mailing Address - Phone:801-446-1515
Mailing Address - Fax:801-446-5290
Practice Address - Street 1:2651 W 10400 S
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8953
Practice Address - Country:US
Practice Address - Phone:801-446-1515
Practice Address - Fax:801-446-5290
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT3432911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry