Organization
ROBERTS FAMILY DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RESA JOHNELLE ROBERTS (CORPORATE OFFICER)
(404) 556-1393
Entity
Organization
Contact information
Practice address
3660 FLAT SHOALS ROAD, SUITE 100, DECATUR, GA 30034-1632
(404) 243-0217
(404) 243-9313
Mailing address
PO BOX 370777, DECATUR, GA 30037-0777
(404) 243-0217
(678) 904-4944
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN010168
GA
122300000X
Dentist
DN012459
GA
122300000X
Dentist
DN013502
GA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN056718
GA
124Q00000X
Dental Hygienist
DH007395
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
559391
UCCI - ROBERTS
GA
Enumeration date
11/06/2006
Last updated
09/29/2010
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