Provider Demographics
NPI:1922201789
Name:ROBERTS, WILLIAM WALTER III (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTER
Last Name:ROBERTS
Suffix:III
Gender:M
Credentials:DMD
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Other - Credentials:
Mailing Address - Street 1:1601 WALNUT STREET
Mailing Address - Street 2:SUITE 1513
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2910
Mailing Address - Country:US
Mailing Address - Phone:215-665-1845
Mailing Address - Fax:215-665-9969
Practice Address - Street 1:1601 WALNUT STREET
Practice Address - Street 2:SUITE 1513
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2910
Practice Address - Country:US
Practice Address - Phone:215-665-1845
Practice Address - Fax:215-665-9969
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS019627L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics