Provider Demographics
NPI:1093445389
Name:ROBERTS, WILLIAM COLBY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:COLBY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 TUCKER DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-5020
Mailing Address - Country:US
Mailing Address - Phone:601-942-8816
Mailing Address - Fax:
Practice Address - Street 1:5647 HIGHWAY 80 E STE 4
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8907
Practice Address - Country:US
Practice Address - Phone:601-936-6108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4292-221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice