Healthcare Provider Details

I. General information

NPI: 1568672947
Provider Name (Legal Business Name): THOMAS W. ROBERTS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 SOUTH DIXIE HIGHWAY
WEST PALM BEACH FL
33405-4602
US

IV. Provider business mailing address

6809 SOUTH DIXIE HIGHWAY
WEST PALM BEACH FL
33405-4602
US

V. Phone/Fax

Practice location:
  • Phone: 561-585-2006
  • Fax: 561-585-2018
Mailing address:
  • Phone: 561-585-2006
  • Fax: 561-585-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: