Provider Demographics
NPI:1508357492
Name:ROBERTS, DALLIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DALLIN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 ROE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2390
Mailing Address - Country:US
Mailing Address - Phone:913-828-0060
Mailing Address - Fax:913-828-0061
Practice Address - Street 1:5201 ROE BLVD
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-2390
Practice Address - Country:US
Practice Address - Phone:913-828-0060
Practice Address - Fax:913-828-0061
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS61347OtherKANSAS DENTAL LICENSE