Provider Demographics
NPI:1366841660
Name:ROBERTS, MICHAEL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16385 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3623
Mailing Address - Country:US
Mailing Address - Phone:760-947-6905
Mailing Address - Fax:
Practice Address - Street 1:16385 WALNUT ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3623
Practice Address - Country:US
Practice Address - Phone:760-947-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist