MEDICARE: DR. STANLEY ALAN ROBERTS DMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10455	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124058961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY ALAN ROBERTS DMP

Provider Business Mailing Address
First Line	:	601 ROCK WOOD DR
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-4531
Country	:	US
Telephone Number	:	781-231-2483
Fax Number	:	781-231-2485

Provider Business Practice Location Address
First Line	:	10 KIRTLAND ST
Second Line	:
City	:	LYNN
State	:	MA
Zip	:	01905-1821
Country	:	US
Telephone Number	:	781-595-2552
Fax Number	:	781-593-0730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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