Provider Demographics
NPI:1225146335
Name:ROBERTS, TWYLA JEAN (DMD PA)
Entity Type:Individual
Prefix:DR
First Name:TWYLA
Middle Name:JEAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 NW 37TH PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6179
Mailing Address - Country:US
Mailing Address - Phone:352-373-7361
Mailing Address - Fax:
Practice Address - Street 1:4121 NW 37TH PL
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6179
Practice Address - Country:US
Practice Address - Phone:352-373-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 143661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice