Provider Demographics
NPI:1083739858
Name:DAVID S. ROBERTS DDS PC
Entity Type:Organization
Organization Name:DAVID S. ROBERTS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-566-9380
Mailing Address - Street 1:7555 CENTER VIEW CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1970
Mailing Address - Country:US
Mailing Address - Phone:801-566-9380
Mailing Address - Fax:
Practice Address - Street 1:7555 CENTER VIEW CT
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1970
Practice Address - Country:US
Practice Address - Phone:801-566-9380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14387799221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00626529OtherUNITED CONCORDIA INS
UT2243877UTOtherDELTA DENTAL OF NJ
UT552172150018Medicaid