Provider Demographics
NPI:1992698021
Name:ROTH, TRENT ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TRENT
Middle Name:ALAN
Last Name:ROTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19770 Q RD
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8074
Mailing Address - Country:US
Mailing Address - Phone:402-750-0348
Mailing Address - Fax:
Practice Address - Street 1:1100 COLUMBINE DR STE B
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-8839
Practice Address - Country:US
Practice Address - Phone:785-364-3038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS62288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist