Provider Demographics
NPI:1750884938
Name:ROBERTS, DREW (DDS)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114508 S 4745 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-5948
Mailing Address - Country:US
Mailing Address - Phone:479-629-3305
Mailing Address - Fax:
Practice Address - Street 1:11414 W MARKHAM ST STE A
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2847
Practice Address - Country:US
Practice Address - Phone:501-404-0529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1047061223G0001X
AR46531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice