Provider Demographics
NPI:1659933240
Name:JOHN T ROSHTO DDS LLC
Entity Type:Organization
Organization Name:JOHN T ROSHTO DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-262-4150
Mailing Address - Street 1:16606 GREENWELL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4128
Mailing Address - Country:US
Mailing Address - Phone:225-262-4150
Mailing Address - Fax:
Practice Address - Street 1:16606 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-4128
Practice Address - Country:US
Practice Address - Phone:225-262-4150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty