Most Relevant Information
Provider Data
| NPI Number: | 1003211780 |
| Provider Name: | LARRY ROTH |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | 019.016425 |
Most Important Dates
| Enumeration Date: | 10/24/2014 |
| Last Updated: | 10/24/2014 |
Provider Practice Location
1637 W WABANSIA AVE
CHICAGO
IL
606221443
Practice Location Phone/Fax
| Phone: | 7734861286 |
| Fax: |
Provider Mailing Location
1637 W WABANSIA AVE
CHICAGO
IL
606221443
Provider Mailing Phone/Fax
| Phone: | 7734861286 |
| Fax: | 7734861287 |