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General NPI Number Information
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NPI Number | 1003891748
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Entity Type | Individual
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Provider Name | RAYNESE S. ROBERTS D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | PSC 808 BOX 19
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City | FPO
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State | AE
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Zip | 09618
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Country | US
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Telephone | 81-811-6000
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Fax |
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Provider Business Mailing Address
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Address Line | U.S. NAVAL HOSPITAL VIA CONTRADA BOSCARIELLO
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City | GRICIGNANO DI AVERSA
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State | CE
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Zip | 81030
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Country | IT
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 30.020955
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 53140
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License Number State | CA
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