Provider Demographics
NPI:1720128226
Name:RENE WELCH ROBERTS, D.M.D., P.C.
Entity Type:Organization
Organization Name:RENE WELCH ROBERTS, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:WELCH
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-494-2679
Mailing Address - Street 1:2751 WARM SPRINGS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6858
Mailing Address - Country:US
Mailing Address - Phone:706-494-2679
Mailing Address - Fax:706-494-2697
Practice Address - Street 1:2751 WARM SPRINGS RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6858
Practice Address - Country:US
Practice Address - Phone:706-494-2679
Practice Address - Fax:706-494-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0116401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2161791-UUOtherEMPLOYER STATE ID
GA=========OtherEIN