Provider Demographics
NPI:1467740167
Name:ROTH, ZACHARY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:M
Last Name:ROTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15440 N 71ST ST
Mailing Address - Street 2:# 307
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2197
Mailing Address - Country:US
Mailing Address - Phone:480-383-9034
Mailing Address - Fax:
Practice Address - Street 1:10855 N TATUM BLVD
Practice Address - Street 2:170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3052
Practice Address - Country:US
Practice Address - Phone:480-948-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0082601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice