Provider Demographics
NPI:1790573483
Name:BENJAMIN ROTH DMD PLLC
Entity type:Organization
Organization Name:BENJAMIN ROTH DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-637-0808
Mailing Address - Street 1:13 DIGITAL WAY UNIT 13-14
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-2269
Mailing Address - Country:US
Mailing Address - Phone:978-637-0808
Mailing Address - Fax:
Practice Address - Street 1:13 DIGITAL WAY UNIT 13-14
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-2269
Practice Address - Country:US
Practice Address - Phone:978-637-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty