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General NPI Number Information
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NPI Number | 1518647601
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Entity Type | Individual
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Provider Name | ANTONIO DEMEKTRICK ROBERTS DDS, MHS
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Gender | Male
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 520 HIGHWAY 76 SUITE 9
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City | WHITE HOUSE
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State | TN
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Zip | 37188
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Country | US
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Telephone | 615-672-7221
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Fax | 615-672-7211
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Provider Business Mailing Address
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Address Line | 210 CRAIG MULLEN DRIVE
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City | LAVERGNE
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State | TN
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Zip | 37086
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Country | US
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Telephone | 318-664-1080
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7753
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 13385
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12741
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License Number State | TN
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