Provider Demographics
NPI:1770971228
Name:LOLA J. JOHN-ROBERTS, DMD PC
Entity type:Organization
Organization Name:LOLA J. JOHN-ROBERTS, DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:716-636-1399
Mailing Address - Street 1:8588 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2607
Mailing Address - Country:US
Mailing Address - Phone:716-636-1399
Mailing Address - Fax:716-636-1389
Practice Address - Street 1:8588 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2607
Practice Address - Country:US
Practice Address - Phone:716-636-1399
Practice Address - Fax:716-636-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty