MEDICARE: DR. DREW ROBERTS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	4653	AR
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	104706	CA

General Provider Information

NPI Number	:	1750884938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DREW ROBERTS DDS

Provider Business Mailing Address
First Line	:	475962 E 1111 RD
Second Line	:
City	:	MULDROW
State	:	OK
Zip	:	74948-4810
Country	:	US
Telephone Number	:	479-629-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 LEXINGTON AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-4736
Country	:	US
Telephone Number	:	479-310-8008
Fax Number	:	479-310-8009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	12/05/2025

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