Provider Demographics
NPI:1336264043
Name:ROTH, NEAL ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:ALLEN
Last Name:ROTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:41 ADMIRAL CALLAGHAN LN
Mailing Address - Street 2:SUITE #A
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4000
Mailing Address - Country:US
Mailing Address - Phone:707-552-5644
Mailing Address - Fax:707-552-6936
Practice Address - Street 1:41 ADMIRAL CALLAGHAN LN
Practice Address - Street 2:SUITE #A
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-4000
Practice Address - Country:US
Practice Address - Phone:707-552-5644
Practice Address - Fax:707-552-6936
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA291781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery