Provider Demographics
NPI:1639252232
Name:ROTH, KARI SHEREE (RDH)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:SHEREE
Last Name:ROTH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-0084
Mailing Address - Country:US
Mailing Address - Phone:719-336-5857
Mailing Address - Fax:719-336-0589
Practice Address - Street 1:200 KENDALL DR
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-3940
Practice Address - Country:US
Practice Address - Phone:719-336-8445
Practice Address - Fax:719-336-0589
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904897124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist