# DR JON M. ROBERTS FAMILY DENTISTRY PC

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

## Provider details

- **NPI number:** 1952783722
- **Authorized official:** DR. JON M. ROBERTS (PRESIDENT/DENTIST)
- **Authorized official phone:** (812) 379-9561

## Contact information

- **Practice address:** 2320 NORTHPARK SUITE C., COLUMBUS, IN 47203-4482
- **Practice address phone:** (812) 379-9561
- **Practice address fax:** (812) 372-8157
- **Mailing address:** 2320 NORTHPARK SUITE C., COLUMBUS, IN 47203-4482
- **Mailing address phone:** (812) 379-9561
- **Mailing address fax:** (812) 372-8157

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 06/29/2015
- **Last updated:** 06/29/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100052120A | — | IN |