Provider Demographics
NPI:1558493239
Name:ROBERTS, DONALD L (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 CENTRAL AVE
Mailing Address - Street 2:STE L8
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6686
Mailing Address - Country:US
Mailing Address - Phone:406-652-8411
Mailing Address - Fax:406-652-7905
Practice Address - Street 1:2675 CENTRAL AVE
Practice Address - Street 2:STE L8
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6686
Practice Address - Country:US
Practice Address - Phone:406-652-8411
Practice Address - Fax:406-652-7905
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT14631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011-0364Medicaid