Organization
CHARLES W ROBERTS IV DDS & KARI L LUNDBERG DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES WAITSEL ROBERTS IV DDS (DENTIST)
(704) 664-5437
Entity
Organization
Contact information
Practice address
142 PROFESSIONAL PARK DR, SUITE 100 & 200, MOORESVILLE, NC 28117
(704) 663-1234
(704) 663-7912
Mailing address
142 PROFESSIONAL PARK DR, SUITE 100 & 200, MOORESVILLE, NC 28117
(704) 663-1234
(704) 663-7912
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7002
NC
122300000X
Dentist
Primary
7023
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5902375
—
NC
01
—
902E8
HEALTH CHOICE
NC
Enumeration date
11/28/2006
Last updated
08/22/2020
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