MEDICARE: DANA M ROBERTS DDS INC

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	46424	CA

General Provider Information

NPI Number	:	1619189586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANA M ROBERTS DDS INC

Provider Business Mailing Address
First Line	:	3 GOLDENFIELD
Second Line	:
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656
Country	:	US
Telephone Number	:	949-425-9075
Fax Number	:

Provider Business Practice Location Address
First Line	:	26700 TOWNE CENTRE DRIVE
Second Line	:	SUITE 240
City	:	LAKE FOREST
State	:	CA
Zip	:	92610
Country	:	US
Telephone Number	:	949-581-5151
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANA ROBERTS
Credential	:	D.D.S.
Telephone Number	:	949-581-5151

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	10/21/2008

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