Provider Demographics
NPI:1295874311
Name:JOSEPH ROBERTO DDS AND TRACI A. ROBERTO DDS, PLLC
Entity type:Organization
Organization Name:JOSEPH ROBERTO DDS AND TRACI A. ROBERTO DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-371-8206
Mailing Address - Street 1:531 MOE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3807
Mailing Address - Country:US
Mailing Address - Phone:518-371-8206
Mailing Address - Fax:
Practice Address - Street 1:531 MOE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3807
Practice Address - Country:US
Practice Address - Phone:518-371-8206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty