Active NPI
Daniel H Roth, DDS
- Prosthodontics
- West Bend, WI
National Provider Identifier
1205863099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 1343
- Practice address
- 1713 Vogt Dr
West Bend, WI 53095-8516 - Phone
- (262) 334-3070
- NPI assigned
- Jun 27, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 1343 | WI | Primary |
Addresses
Primary practice location
1713 Vogt Dr
West Bend, WI 53095-8516
Mailing address
509 Summit Dr
West Bend, WI 53095-3853
Phone (262) 334-5249
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1343 | WI | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205863099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "509 SUMMIT DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530953853",
"telephone_number": "262-334-5249"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1713 VOGT DR",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530958516",
"telephone_number": "262-334-3070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "DANIEL",
"middle_name": "H",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "WI",
"license": "1343",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.