Provider Demographics
NPI:1346508397
Name:ROBERTS, DAVID CLARK
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CLARK
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 S MARBLEHEAD RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-7788
Mailing Address - Country:US
Mailing Address - Phone:828-242-1762
Mailing Address - Fax:
Practice Address - Street 1:1632 S MARBLEHEAD RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-7788
Practice Address - Country:US
Practice Address - Phone:828-242-1762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist