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1003211780
LARRY ROTH
CHICAGO, IL
NPI
1003211780
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
122300000X Dentist
(Licence: IL 019.016425)
Enumeration Date
2014-10-24
Last Update Date
2014-10-24
Business Address
-- LARRY ROTH
1637 W WABANSIA AVE
CHICAGO, IL 60622-1443
Phone number: 773-486-1286
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Mailing Address
-- LARRY ROTH
1637 W WABANSIA AVE
CHICAGO, IL 60622-1443
Phone number: 773-486-1286
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