Provider Demographics
NPI:1497751119
Name:ROBERTS, MICHAEL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
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:ORAL SURGERY PLUS
Mailing Address - Street 2:12409 E MISSION #101
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99216
Mailing Address - Country:US
Mailing Address - Phone:509-928-8800
Mailing Address - Fax:509-321-0154
Practice Address - Street 1:12409 E MISSION AVE
Practice Address - Street 2:STE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-3101
Practice Address - Country:US
Practice Address - Phone:509-928-8800
Practice Address - Fax:509-321-0154
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA75001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5033584Medicaid
WAAB18452Medicare ID - Type Unspecified
WA5033584Medicaid