Healthcare Provider Details

I. General information

NPI: 1427130400
Provider Name (Legal Business Name): HOWARD WAYNE ROBERTS DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 A SIXTH ST
GREAT LAKES IL
60088
US

IV. Provider business mailing address

4 REGENT CT W
BUFFALO GROVE IL
60089-1941
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-7670
  • Fax:
Mailing address:
  • Phone: 847-459-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5486
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: