Naomi C Roeder, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D6141 Issued in AZ

Practice address

200 W. Hospital Drive
Whiteriver, AZ 85941

Phone

(928) 338-3615

NPI assigned

Apr 9, 2007

Sex

Female

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391558400000",
    "number": "1588787246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4104",
            "city": "PINETOP",
            "state": "AZ",
            "postal_code": "859354104",
            "telephone_number": "928-367-3305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W. HOSPITAL DRIVE",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "85941",
            "telephone_number": "928-338-3615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROEDER",
        "first_name": "NAOMI",
        "middle_name": "C",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2014-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D6141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "931586",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WHITERIVER",
            "identifier": "092403",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CBQ",
            "identifier": "092461",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renal Care Group Arizona, LLC
• Erin Marie Ressler, PHARMD
• Aldo Enrique Revilla, PHD
• Richard John Robinson, D.P.M.
• Theresa Rodzevik, RN, MSN, FNP
• Agafe Saguros
• Melissa Sams
• Jacob Sandoval, PHARMD
• Kenneth R Say, RPH
• Sequel Tsi of Az, LLC

• General Practice Dentistry in Whiteriver, AZ
• Providers in Whiteriver, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2014; 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.