Individual
JUSTIN L ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3415 S LAFOUNTAIN ST STE I, KOKOMO, IN 46902-3826
(765) 455-1222
(765) 455-0485
Mailing address
10450 E 500 S, KIRKLIN, IN 46050-8800
(317) 850-2327
(765) 455-0485
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12012271A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2011
Last updated
12/22/2020
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