MEDICARE: R KENDALL ROBERTS DDS

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	2787	AR

General Provider Information

NPI Number	:	1396881421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	R KENDALL ROBERTS DDS

Provider Business Mailing Address
First Line	:	5505 EUPER LN
Second Line	:	SUITE B
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3233
Country	:	US
Telephone Number	:	479-478-6060
Fax Number	:	479-478-6122

Provider Business Practice Location Address
First Line	:	5505 EUPER LN
Second Line	:	SUITE B
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3233
Country	:	US
Telephone Number	:	479-478-6060
Fax Number	:	479-478-6122

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	01/24/2011

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