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NPI Code Detail

MEDICARE: ROBERTS, WALLACE & ASSOCIATES PLLC

MEDICARE: ROBERTS, WALLACE & ASSOCIATES PLLC
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
11223G0001XGeneral Practice Dentistry9846NC

Other Identifiers

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

General Provider Information

NPI Number : 1578054557
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERTS, WALLACE & ASSOCIATES PLLC
Provider Business Mailing Address
First Line : 2643 RANDLEMAN RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27406-5153
Country : US
Telephone Number : 480-866-8811
Fax Number :
Provider Business Practice Location Address
First Line : 2643 RANDLEMAN RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27406-5153
Country : US
Telephone Number : 336-544-2758
Fax Number : 910-338-3031
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : TERESA ZWICKY
Credential :
Telephone Number : 480-866-8811
Provider Enumeration Date : 05/24/2018
Last Update Date : 08/15/2025

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