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General NPI Number Information
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NPI Number | 1053596429
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Entity Type | Organization
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Legal Business Name | DR. GREG A. ROBERTS P.C.
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 5742 S 1475 E STE 100
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City | OGDEN
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State | UT
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Zip | 84403-4857
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Country | US
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Telephone | 801-479-9070
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Fax | 801-479-9078
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Provider Business Mailing Address
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Address Line | 5742 S 1475 E STE 100
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City | OGDEN
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State | UT
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Zip | 84403-4857
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Country | US
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Telephone | 801-479-9070
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Fax | 801-479-9078
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Authorized Official
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Title or Position | ORAL & MAXILLOFACIAL SURGEON
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Name | GREG A ROBERTS
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Credential | DDS
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Telephone | 801-479-9070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 1451579924
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License Number State | UT
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