Provider Demographics
NPI:1841384526
Name:ROBERTS, CHRISTOPHER EUGENE (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:EUGENE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ELKIN HIGHWAY
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:336-667-8332
Practice Address - Street 1:106 ELKIN HIGHWAY
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:336-667-8332
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899015UMedicaid