Organization
DR. TONY ROBERTS D.D.S. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TONY LEON ROBERTS DDS (MANAGING MEMBER)
(719) 542-6014
Entity
Organization
Contact information
Practice address
517 W 5TH ST, STE 106, PUEBLO, CO 81003-3185
(719) 542-6014
(719) 583-7937
Mailing address
5623 TERRACINA PL, PUEBLO, CO 81005-5582
(719) 542-6014
(719) 583-7937
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
105202
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02052025
—
CO
05
—
46201751
—
CO
Enumeration date
12/21/2007
Last updated
08/09/2012
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