Organization
J. SHANE ROBERTS FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY SHANE ROBERTS (DENTIST)
(205) 744-4258
Entity
Organization
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
261QD0000X
Dental Clinic/Center
Primary
4013
AL
Other
Enumeration date
09/07/2017
Last updated
09/07/2017
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