Provider Demographics
NPI:1710907092
Name:ROTH, SEAN ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:ALLEN
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 1:2370 E BIDWELL ST
Mailing Address - Street 2:#110
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3892
Mailing Address - Country:US
Mailing Address - Phone:916-983-1114
Mailing Address - Fax:916-983-1104
Practice Address - Street 1:2370 E BIDWELL ST
Practice Address - Street 2:#110
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3892
Practice Address - Country:US
Practice Address - Phone:916-983-1114
Practice Address - Fax:916-983-1104
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice