Individual
DR. J SHANE ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
904 4TH ST, PLEASANT GROVE, AL 35127-1059
(205) 744-4258
(205) 744-4255
Mailing address
PO BOX 445, PLEASANT GROVE, AL 35127-0445
(205) 744-4258
(205) 744-4255
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4013
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15995
BCBS PROVIDER #
AL
01
—
87708
UNITED CONCORDIA PROV #
PA
Enumeration date
05/18/2007
Last updated
07/08/2007
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