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General NPI Number Information
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NPI Number | 1518103787
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Entity Type | Organization
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Legal Business Name | RONALD G. ROBERTS, D.D.S.
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 409 CHURCH AVENUE
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City | HUNTSVILLE
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State | AR
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Zip | 72740-0249
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Country | US
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Telephone | 479-738-2777
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Fax | 479-738-2705
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Provider Business Mailing Address
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Address Line | PO BOX 249 409 CHURCH AVENUE
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City | HUNTSVILLE
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State | AR
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Zip | 72740-0249
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Country | US
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Telephone | 479-738-2777
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Fax | 479-738-2705
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD GLENN ROBERTS
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Credential | D.D.S.
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Telephone | 479-738-2777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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