Provider Demographics
NPI:1821254004
Name:ROTH, STEVEN E (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
Last Name:ROTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 NE 2ND AVE
Mailing Address - Street 2:SUITE200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2509
Mailing Address - Country:US
Mailing Address - Phone:305-358-3384
Mailing Address - Fax:
Practice Address - Street 1:138 NE 2ND AVE
Practice Address - Street 2:SUITE200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2509
Practice Address - Country:US
Practice Address - Phone:305-358-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12059122300000X, 1223G0001X, 1223P0300X, 1223P0700X, 1223S0112X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics
No1223P0700XDental ProvidersDentistProsthodontics
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN12059OtherLICENSE NUMBER