Provider Demographics
NPI:1376743369
Name:ROTH, WILLIAM CARTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CARTER
Last Name:ROTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2116 HOLLOW BROOK DR
Mailing Address - Street 2:SIUTE # 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1443
Mailing Address - Country:US
Mailing Address - Phone:719-597-0038
Mailing Address - Fax:719-597-6239
Practice Address - Street 1:2116 HOLLOW BROOK DR
Practice Address - Street 2:SIUTE # 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1442
Practice Address - Country:US
Practice Address - Phone:719-597-0038
Practice Address - Fax:719-597-6239
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO75211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics