Provider Demographics
NPI:1851441919
Name:ROTH, SETH MARC (DMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:MARC
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 1:450 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-1610
Mailing Address - Country:US
Mailing Address - Phone:781-344-5543
Mailing Address - Fax:781-344-9851
Practice Address - Street 1:450 PEARL ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-1610
Practice Address - Country:US
Practice Address - Phone:781-344-5543
Practice Address - Fax:781-344-9851
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice