Provider Demographics
NPI:1437171584
Name:ROBERTS, MICHAEL WELLS (DDS, MSCD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WELLS
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS, MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DENTAL CIR
Mailing Address - Street 2:DENTAL FACULTY PRACTICE CB7450
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 DENTAL CIR
Practice Address - Street 2:DENTAL FACULTY PRACTICE CB7450
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7450
Practice Address - Country:US
Practice Address - Phone:919-537-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00231223P0221X
TX80831223P0221X
CA217481223P0221X
DCDEN1571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZZ5138Medicaid
NC89-97452Medicaid
97452OtherBCBS
2428323Medicare ID - Type Unspecified
U28200Medicare UPIN