Organization
DR JON M. ROBERTS FAMILY DENTISTRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON M. ROBERTS (PRESIDENT/DENTIST)
(812) 379-9561
Entity
Organization
Contact information
Practice address
2320 NORTHPARK SUITE C., COLUMBUS, IN 47203-4482
(812) 379-9561
(812) 372-8157
Mailing address
2320 NORTHPARK SUITE C., COLUMBUS, IN 47203-4482
(812) 379-9561
(812) 372-8157
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100052120A
—
IN
Enumeration date
06/29/2015
Last updated
06/29/2015
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