Provider Demographics
NPI:1740471184
Name:ROBERTS, BRIAN B (DDS PLC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS PLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4365 E PECOS RD STE 137
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8053
Mailing Address - Country:US
Mailing Address - Phone:480-507-1943
Mailing Address - Fax:
Practice Address - Street 1:4365 E PECOS RD STE 137
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8053
Practice Address - Country:US
Practice Address - Phone:480-507-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7364122300000X
AZD073641223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No122300000XDental ProvidersDentist