Organization
J KEITH ROBERTS DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
J KEITH ROBERTS D.D.S. (OWNER)
(812) 333-5437
Entity
Organization
Contact information
Practice address
828 S AUTO MALL RD, BLOOMINGTON, IN 47401-5430
(812) 333-5437
(812) 333-6305
Mailing address
828 S AUTO MALL RD, BLOOMINGTON, IN 47401-5430
(812) 333-5437
(812) 333-6305
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100060010A
—
IN
Enumeration date
09/09/2009
Last updated
02/10/2011
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