Provider Demographics
NPI:1447390414
Name:ROBLETO, INDIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:INDIANA
Middle Name:
Last Name:ROBLETO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12940 THIRTEENTH STREET
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-465-0111
Mailing Address - Fax:909-465-0018
Practice Address - Street 1:12940 13TH ST
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4359
Practice Address - Country:US
Practice Address - Phone:909-465-0111
Practice Address - Fax:909-465-0018
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA514357OtherDENTICAL