Jeffrey R Roth, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3778 Issued in ID

Practice address

408 S Main St Ste 1
Hailey, ID 83333-8402

Phone

(208) 788-7766

Fax

(208) 788-9920

NPI assigned

Nov 6, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287446400000",
    "number": "1144399189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 727",
            "address_2": "408 SOUTH MAIN STREET, SUITE 1",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833330727",
            "telephone_number": "208-788-7766",
            "fax_number": "208-788-9920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 S MAIN ST STE 1",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833338402",
            "telephone_number": "208-788-7766",
            "fax_number": "208-788-9920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "JEFFREY",
        "middle_name": "R",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2010-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806932600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Hailey, ID
• Providers in Hailey, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.