MEDICARE: DR JON M. ROBERTS FAMILY DENTISTRY PC

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	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952783722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JON M. ROBERTS FAMILY DENTISTRY PC

Provider Business Mailing Address
First Line	:	2320 NORTHPARK SUITE C.
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4482
Country	:	US
Telephone Number	:	812-379-9561
Fax Number	:	812-372-8157

Provider Business Practice Location Address
First Line	:	2320 NORTHPARK SUITE C.
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4482
Country	:	US
Telephone Number	:	812-379-9561
Fax Number	:	812-372-8157

Authorized Official
Title or Position	:	PRESIDENT/DENTIST
Name	:	DR. JON M. ROBERTS
Credential	:
Telephone Number	:	812-379-9561

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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