Provider Demographics
NPI:1366689093
Name:T. LUKE ROBERTS, DMD, MSD, PA
Entity Type:Organization
Organization Name:T. LUKE ROBERTS, DMD, MSD, PA
Other - Org Name:BLUE RIDGE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LUTHER
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:828-687-0872
Mailing Address - Street 1:2 WALDEN RIDGE DRIVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803
Mailing Address - Country:US
Mailing Address - Phone:828-687-0872
Mailing Address - Fax:
Practice Address - Street 1:2 WALDEN RIDGE DRIVE
Practice Address - Street 2:SUITE 50
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-687-0872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty