Provider Demographics
NPI:1245073360
Name:ROTI, CAROLINE (DMD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:ROTI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 SAINT LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1311
Mailing Address - Country:US
Mailing Address - Phone:630-418-1184
Mailing Address - Fax:
Practice Address - Street 1:1490 N GREEN MOUNT RD STE A
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-3484
Practice Address - Country:US
Practice Address - Phone:618-622-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019035184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist