Provider Demographics
NPI:1558436717
Name:ROTT, ROANLD RALPH (DDS)
Entity Type:Individual
Prefix:
First Name:ROANLD
Middle Name:RALPH
Last Name:ROTT
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 1:2525 K ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5114
Mailing Address - Country:US
Mailing Address - Phone:916-444-7460
Mailing Address - Fax:916-444-3465
Practice Address - Street 1:2525 K ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5114
Practice Address - Country:US
Practice Address - Phone:916-444-7460
Practice Address - Fax:916-444-3465
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175451223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics