Provider Demographics
NPI:1376567446
Name:ROBERTS, FREDERICK ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:ALAN
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 1:20800 WESTGATE MALL
Mailing Address - Street 2:#404
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1323
Mailing Address - Country:US
Mailing Address - Phone:440-333-4063
Mailing Address - Fax:440-333-5688
Practice Address - Street 1:20800 WESTGATE MALL
Practice Address - Street 2:#404
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-1323
Practice Address - Country:US
Practice Address - Phone:440-333-4063
Practice Address - Fax:440-333-5688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist