Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | DA0000002942 | TN |
NPI | 1285719427 |
---|---|
Provider Name | Mrs. Patricia A. Roth |
First Address | Spring Hill, TN 37174-2859 |
Second Address | Spring Hill, TN 37174-8607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 08/07/2007 |