Provider Demographics
NPI:1629593108
Name:ROBERTS, HILLARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HILLARY
Middle Name:
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 1:22 HOUGHTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:VT
Mailing Address - Zip Code:05354-9643
Mailing Address - Country:US
Mailing Address - Phone:602-920-6829
Mailing Address - Fax:
Practice Address - Street 1:1046 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7144
Practice Address - Country:US
Practice Address - Phone:802-254-2384
Practice Address - Fax:802-254-2384
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0130587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT016.0130587OtherVERMONT STATE BOARD