Provider Demographics
NPI:1083822324
Name:CHARLES E. ROBERTS, DDS, PC
Entity Type:Organization
Organization Name:CHARLES E. ROBERTS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-747-8080
Mailing Address - Street 1:5101 E FARNESS DR
Mailing Address - Street 2:SUITE #C
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6116
Mailing Address - Country:US
Mailing Address - Phone:520-747-8080
Mailing Address - Fax:520-323-1463
Practice Address - Street 1:5101 E FARNESS DR
Practice Address - Street 2:SUITE #C
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6116
Practice Address - Country:US
Practice Address - Phone:520-747-8080
Practice Address - Fax:520-323-1463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ00480861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty