Provider Demographics
NPI:1134432743
Name:CHRIS R ROBERTS DDS, PC
Entity type:Organization
Organization Name:CHRIS R ROBERTS DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:303-371-4485
Mailing Address - Street 1:4809 ARGONNE ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-6834
Mailing Address - Country:US
Mailing Address - Phone:303-371-4485
Mailing Address - Fax:303-371-3904
Practice Address - Street 1:4809 ARGONNE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-6834
Practice Address - Country:US
Practice Address - Phone:303-371-4485
Practice Address - Fax:303-371-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-24
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47684291Medicaid