Provider Demographics
NPI:1740417120
Name:ROBERT, CHELSEY L ROBERTS (DDS)
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:L ROBERTS
Last Name:ROBERT
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 1:207 E CAPITOL AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3192
Mailing Address - Country:US
Mailing Address - Phone:605-224-2161
Mailing Address - Fax:
Practice Address - Street 1:207 E CAPITOL AVE STE 207
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3192
Practice Address - Country:US
Practice Address - Phone:605-224-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD09141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice