Provider Demographics
NPI:1073721221
Name:FORD G. ROBERTS D.D.S. INC.
Entity Type:Organization
Organization Name:FORD G. ROBERTS D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FORD
Authorized Official - Middle Name:GIBSON
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-846-3248
Mailing Address - Street 1:1472 CEDARWOOD LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6149
Mailing Address - Country:US
Mailing Address - Phone:925-846-3248
Mailing Address - Fax:
Practice Address - Street 1:1472 CEDARWOOD LN
Practice Address - Street 2:SUITE A
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6149
Practice Address - Country:US
Practice Address - Phone:925-846-3248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD198001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty