Individual
DR. MICAH A ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4517 N ROCKWOOD DR, PEORIA, IL 61615-3841
(309) 693-0043
(309) 688-5643
Mailing address
4517 N ROCKWOOD DR, PEORIA, IL 61615-3841
(309) 688-0121
(309) 688-5643
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019.029023
IL
1223G0001X
General Practice Dentistry
Primary
019029023
IL
Other
Enumeration date
06/25/2012
Last updated
10/06/2020
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