=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689822249
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER E. ROBERTS, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2008
-----------------------------------------------------
Last Update Date | 09/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 ELKIN HWY
-----------------------------------------------------
City | NORTH WILKESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-667-9991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 ELKIN HWY
-----------------------------------------------------
City | NORTH WILKESBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28659
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-667-9991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | DR. CHRISTOPHER E ROBERTS
-----------------------------------------------------
Credential | DDS, PA
-----------------------------------------------------
Telephone | 336-667-9991
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | NC7171
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------