Larry Roth

NPI #1003211780 in Chicago, Illinois

Provider Information

NPI Number: 1003211780
Entity Type: Individual
Name: Larry Roth
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist
Enumeration Date: Oct 24, 2014
Last Updated: Oct 24, 2014

Practice Location

Address: 1637 W WABANSIA AVE
City: Chicago
State: Illinois
ZIP Code: 60622-1443
Phone: (773) 486-1286

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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