Provider Demographics
NPI:1700196870
Name:ROBERTS, KRYSTAL LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:LYNN
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 1:2811 BUSINESS CENTER DR
Mailing Address - Street 2:PEARLAND MODERN DENTISTRY
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:713-444-5628
Mailing Address - Fax:
Practice Address - Street 1:2811 BUSINESS CENTER DR
Practice Address - Street 2:PEARLAND MODERN DENTISTRY
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:713-444-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist