Individual
ROBERT THEODORE ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
632 FRIARS POINT RD, CLARKSDALE, MS 38614-9111
(662) 624-6862
(662) 624-5985
Mailing address
632 FRIARS POINT RD, CLARKSDALE, MS 38614-9111
(662) 624-6862
(662) 624-5985
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
147071
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00062287
—
MS
Enumeration date
03/21/2007
Last updated
07/09/2007
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