Provider Demographics
NPI:1710993639
Name:ROBERTS, LEWIS H (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:H
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:LEWIS
Other - Middle Name:H
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1247 CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-3256
Mailing Address - Country:US
Mailing Address - Phone:505-662-2585
Mailing Address - Fax:
Practice Address - Street 1:1247 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3256
Practice Address - Country:US
Practice Address - Phone:505-662-2585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist