Provider Demographics
NPI:1689822249
Name:CHRISTOPHER E. ROBERTS, DDS, PA
Entity Type:Organization
Organization Name:CHRISTOPHER E. ROBERTS, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:336-667-9991
Mailing Address - Street 1:106 ELKIN HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659
Mailing Address - Country:US
Mailing Address - Phone:336-667-9991
Mailing Address - Fax:
Practice Address - Street 1:106 ELKIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659
Practice Address - Country:US
Practice Address - Phone:336-667-9991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC71711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9202559Medicaid
NC899015UMedicaid