Provider Demographics
NPI:1427233212
Name:WILLIAM C ROTH DDS PC
Entity Type:Organization
Organization Name:WILLIAM C ROTH DDS PC
Other - Org Name:FRONT RANGE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-597-0038
Mailing Address - Street 1:2116 HOLLOW BROOK DRIVE #200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-597-0038
Mailing Address - Fax:719-597-6239
Practice Address - Street 1:2116 HOLLOW BROOK DRIVE #200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-597-0038
Practice Address - Fax:719-597-6239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty