Provider Demographics
NPI:1053504761
Name:ROBERTS, CRAIG T (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:T
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 WASHINGTON SQ W
Mailing Address - Street 2:SUITE 2 F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-9126
Mailing Address - Country:US
Mailing Address - Phone:212-598-4855
Mailing Address - Fax:
Practice Address - Street 1:31 WASHINGTON SQ W
Practice Address - Street 2:SUITE 2 F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9126
Practice Address - Country:US
Practice Address - Phone:212-598-4855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist