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NPI Code Detail

MEDICARE: ROBERTS & LO PLLC

MEDICARE: ROBERTS & LO PLLC
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
11223D0004XDental Anesthesiology

General Provider Information

NPI Number : 1932676848
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERTS & LO PLLC
Provider Business Mailing Address
First Line : 5717 E THOMAS RD STE 110
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85251-7620
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2643 RANDLEMAN RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27406-5153
Country : US
Telephone Number : 336-544-2758
Fax Number :
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : BRIDGET SHIELDS
Credential :
Telephone Number : 480-406-8677
Provider Enumeration Date : 10/29/2018
Last Update Date : 10/29/2018

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