Provider Demographics
NPI:1841468659
Name:ROTH, CRAIG ALLAN (DMD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALLAN
Last Name:ROTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 NORTH KROME AVE
Mailing Address - Street 2:SUITE #207
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030
Mailing Address - Country:US
Mailing Address - Phone:305-248-3883
Mailing Address - Fax:305-248-6698
Practice Address - Street 1:950 NORTH KROME AVE
Practice Address - Street 2:SUITE #207
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030
Practice Address - Country:US
Practice Address - Phone:305-248-3883
Practice Address - Fax:305-248-6698
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013755122300000X
MA18415122300000X
AL4603122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist