Healthcare Provider Details

I. General information

NPI: 1740893791
Provider Name (Legal Business Name): TRENT WILLIAM ROBERTS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4891 OLD YORK RD
ROCK HILL SC
29732-8375
US

IV. Provider business mailing address

4424 GOLDEN VIEW DR
CHARLOTTE NC
28278-0205
US

V. Phone/Fax

Practice location:
  • Phone: 803-326-0100
  • Fax:
Mailing address:
  • Phone: 817-705-7639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS042900
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10327
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: