Provider Demographics
NPI:1881787968
Name:ROTH & MANN II, DDS, PA
Entity type:Organization
Organization Name:ROTH & MANN II, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-696-6394
Mailing Address - Street 1:303 S WALTON DR
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-9396
Mailing Address - Country:US
Mailing Address - Phone:919-894-1612
Mailing Address - Fax:919-894-2556
Practice Address - Street 1:303 S WALTON DR
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-9396
Practice Address - Country:US
Practice Address - Phone:919-894-1612
Practice Address - Fax:919-894-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902667Medicaid