Organization
R TED ROBERTS DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
R TED ROBERTS DDS PA (PRESIDENT)
(662) 624-6862
Entity
Organization
Contact information
Practice address
632 FRIARS POINT ROAD, CLARKSDALE, MS 38614
(662) 624-6862
(662) 624-5985
Mailing address
632 FRIARS POINT ROAD, CLARKSDALE, MS 38614
(662) 624-6862
(662) 624-5985
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
147071
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00062287
—
MS
05
—
03036322
—
MS
Enumeration date
09/01/2006
Last updated
08/22/2020
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