Provider Demographics
NPI:1801056650
Name:ROBERTS, ALEX R (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:R
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 1:8022 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-2250
Mailing Address - Country:US
Mailing Address - Phone:785-766-4991
Mailing Address - Fax:
Practice Address - Street 1:4527 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-3428
Practice Address - Country:US
Practice Address - Phone:913-432-0765
Practice Address - Fax:913-432-6022
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist