Larry Roth
Dentist
1637 W Wabansia Ave
Chicago
, Illinois 60622-1443
(773) 486-1287
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About
Features
Specialties
- Dentist
Languages spoken
- English
Location
First Address
- Larry Roth
- 1637 W Wabansia Ave
- Chicago, IL
- Zip : 60622-1443
- Fax : (773) 486-1287
- Phone : (773) 486-1286
Second Address
- Larry Roth
- 1637 W Wabansia Ave
- Chicago, IL
- Zip : 60622-1443
- Phone : (773) 486-1286
Reviews
FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 122300000X | Dentist | 019.016425 | IL |
National Provider Identifier
| NPI | 1003211780 |
|---|---|
| Provider Name | Larry Roth |
| First Address | Chicago, IL 60622-1443 |
| Second Address | Chicago, IL 60622-1443 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/10/2014 |
| Last Update Date | 24/10/2014 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.