Provider Demographics
NPI:1730662446
Name:ROTH, DANIEL STEVEN
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:STEVEN
Last Name:ROTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-9320
Mailing Address - Country:US
Mailing Address - Phone:937-286-4884
Mailing Address - Fax:
Practice Address - Street 1:460 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-9320
Practice Address - Country:US
Practice Address - Phone:937-286-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty