Provider Demographics
NPI:1619672631
Name:ROBERTS, LAURA ROCHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ROCHELLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 MADDEN ST
Mailing Address - Street 2:
Mailing Address - City:TONTITOWN
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2211
Mailing Address - Country:US
Mailing Address - Phone:903-280-6390
Mailing Address - Fax:
Practice Address - Street 1:3555 HIGHWAY 412 E STE 10
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-7090
Practice Address - Country:US
Practice Address - Phone:479-373-5031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-31
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AR4690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program