Active NPI
Elisa Marie Roth, D.M.D.
- Dentist
- Camp Lejeune, NC
National Provider Identifier
1790981298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019.027394
- Practice address
- 100 Brewster Blvd
Naval Hospital
Camp Lejeune, NC 28547-2538 - Phone
- (309) 349-2470
- NPI assigned
- Jun 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 019.027394 | IL | Primary |
Addresses
Primary practice location
100 Brewster Blvd
Naval Hospital
Camp Lejeune, NC 28547-2538
Mailing address
115 Blossom Cir
Hampstead, NC 28443-3281
Phone (309) 349-2470
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 |
|---|---|---|---|
| 019.027394 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407801600000",
"number": "1790981298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 BLOSSOM CIR",
"city": "HAMPSTEAD",
"state": "NC",
"postal_code": "284433281",
"telephone_number": "309-349-2470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BREWSTER BLVD",
"address_2": "NAVAL HOSPITAL",
"city": "CAMP LEJEUNE",
"state": "NC",
"postal_code": "285472538",
"telephone_number": "309-349-2470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "ELISA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-22",
"last_updated": "2014-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019.027394",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camp Lejeune, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.