MEDICARE: DR. ANTONIO DEMEKTRICK ROBERTS DDS, MHS

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	1223P0221X	Pediatric Dentistry	7753	LA
2	1223P0221X	Pediatric Dentistry	13385	NC
3	1223P0221X	Pediatric Dentistry	12741	TN

General Provider Information

NPI Number	:	1518647601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTONIO DEMEKTRICK ROBERTS DDS, MHS

Provider Business Mailing Address
First Line	:	2235 S MACARTHUR DR STE B
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3063
Country	:	US
Telephone Number	:	318-473-9544
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 S MACARTHUR DR STE B
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3063
Country	:	US
Telephone Number	:	318-473-9544
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	02/09/2026

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