Provider Demographics
NPI:1285719427
Name:ROTH, PATRICIA A (RDA)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:ROTH
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 LEXINGTON FARMS LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2859
Mailing Address - Country:US
Mailing Address - Phone:615-302-2407
Mailing Address - Fax:
Practice Address - Street 1:5073 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-8607
Practice Address - Country:US
Practice Address - Phone:615-302-4202
Practice Address - Fax:615-302-4203
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDA0000002942126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant