Provider Demographics
NPI:1578822284
Name:ROBERTS, JAMIE ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ELIZABETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AMELIA DR
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-6064
Mailing Address - Country:US
Mailing Address - Phone:765-860-5150
Mailing Address - Fax:
Practice Address - Street 1:401 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2703
Practice Address - Country:US
Practice Address - Phone:508-228-5508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413409122300000X
IL019.028487122300000X
MADN1856973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist