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General NPI Number Information
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NPI Number | 1801962196
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Entity Type | Organization
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Legal Business Name | CHARLES W ROBERTS IV DDS & KARI L LUNDBERG DDS PA
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 142 PROFESSIONAL PARK DR SUITE 100 & 200
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City | MOORESVILLE
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State | NC
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Zip | 28117
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Country | US
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Telephone | 704-663-1234
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Fax | 704-663-7912
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Provider Business Mailing Address
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Address Line | 142 PROFESSIONAL PARK DR SUITE 100 & 200
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City | MOORESVILLE
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State | NC
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Zip | 28117
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Country | US
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Telephone | 704-663-1234
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Fax | 704-663-7912
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHARLES WAITSEL ROBERTS IV
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Credential | DDS
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Telephone | 704-664-5437
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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 | 7002
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7023
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License Number State | NC
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