Provider Demographics
NPI:1730474727
Name:ROBERTS, MARTIN CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:CHARLES
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 FOLSOM ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5713
Mailing Address - Country:US
Mailing Address - Phone:303-442-4810
Mailing Address - Fax:303-415-9155
Practice Address - Street 1:1900 FOLSOM ST
Practice Address - Street 2:SUITE 111
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5713
Practice Address - Country:US
Practice Address - Phone:303-442-4810
Practice Address - Fax:303-415-9155
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1053471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice