Provider Demographics
NPI:1932488210
Name:ROBERTS, ASHLEY THEODORE (DMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:THEODORE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 SAINT ROSE PKWY UNIT 777112
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-8805
Mailing Address - Country:US
Mailing Address - Phone:702-553-6762
Mailing Address - Fax:855-655-4767
Practice Address - Street 1:3055 SAINT ROSE PKWY UNIT 777112
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89077-8805
Practice Address - Country:US
Practice Address - Phone:702-553-6762
Practice Address - Fax:855-655-4767
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0094351223D0004X
NV61711223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist