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General NPI Number Information
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NPI Number | 1760664015
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Entity Type | Organization
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Legal Business Name | CASEY A ROBERTS DDS PC
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 2425 W. UNIVERSITY BLVD. STE. 102
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City | DURANT
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State | OK
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Zip | 74701
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Country | US
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Telephone | 580-924-3330
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Fax | 580-924-3339
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Provider Business Mailing Address
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Address Line | 2425 W. UNIVERSITY BLVD. STE. 102
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City | DURANT
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State | OK
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Zip | 74701
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Country | US
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Telephone | 580-924-3330
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Fax | 580-924-3339
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CASEY A ROBERTS
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Credential | D.D.S.
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Telephone | 580-924-3330
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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 | 5808
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License Number State | OK
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