Provider Demographics
NPI:1972864528
Name:ROBERTS, AARON LEGRAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:LEGRAND
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11765
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85318-1765
Mailing Address - Country:US
Mailing Address - Phone:602-513-2242
Mailing Address - Fax:
Practice Address - Street 1:625 W SOUTHERN AVE
Practice Address - Street 2:STE E-145
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-5030
Practice Address - Country:US
Practice Address - Phone:602-513-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0094411223D0004X
TX318191223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist