Provider Demographics
NPI:1205097946
Name:ROBERTS, RYAN SCOTT (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:SCOTT
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4444 S HARVARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2611
Mailing Address - Country:US
Mailing Address - Phone:918-970-4944
Mailing Address - Fax:
Practice Address - Street 1:4444 S HARVARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2611
Practice Address - Country:US
Practice Address - Phone:918-970-4944
Practice Address - Fax:918-970-4953
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty