Provider Demographics
NPI:1558450346
Name:ROBERTS, JAMES A
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706
Mailing Address - Country:US
Mailing Address - Phone:260-925-4660
Mailing Address - Fax:260-925-4661
Practice Address - Street 1:102 N CLARK ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706
Practice Address - Country:US
Practice Address - Phone:260-925-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006554A1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health