# ROBERTS DENTAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811601800
- **Authorized official:** DR. JUSTIN LEVI ROBERTS DDS (OWNER)
- **Authorized official phone:** (765) 455-1222

## Contact information

- **Practice address:** 3415 S LAFOUNTAIN ST STE I, KOKOMO, IN 46902-3826
- **Practice address phone:** (765) 455-1222
- **Practice address fax:** (765) 455-0485
- **Mailing address:** 3415 S LAFOUNTAIN ST STE I, KOKOMO, IN 46902-3826
- **Mailing address phone:** (765) 455-1222
- **Mailing address fax:** (765) 455-0485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 01/13/2023
- **Last updated:** 01/13/2023