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General NPI Number Information
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NPI Number | 1275774952
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Entity Type | Individual
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Provider Name | CHARLES A ROBERTS DDS
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Gender | Male
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 03/10/2009
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Provider Practice Location Address
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Address Line | 75-1028 HENRY ST STE. 203
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City | KAILUA KONA
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State | HI
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Zip | 96740-1693
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Country | US
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Telephone | 808-329-4425
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Fax | 808-329-0872
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Provider Business Mailing Address
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Address Line | 555 W BENJAMIN HOLT DR BLDG. B
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City | STOCKTON
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State | CA
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Zip | 95207-3839
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Country | US
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Telephone | 209-476-4700
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Fax | 209-478-6890
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 1065
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License Number State | HI
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