Provider Demographics
NPI:1043748411
Name:ROBERTS, ANNIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:KS
Mailing Address - Zip Code:66075-4065
Mailing Address - Country:US
Mailing Address - Phone:913-235-1141
Mailing Address - Fax:
Practice Address - Street 1:113 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LA CYGNE
Practice Address - State:KS
Practice Address - Zip Code:66040-4205
Practice Address - Country:US
Practice Address - Phone:913-757-4429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist