Provider Demographics
NPI:1770620171
Name:ROBERTS, CAROLE REAMS (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:REAMS
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 TIMBERLAKE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2608
Mailing Address - Country:US
Mailing Address - Phone:434-239-2651
Mailing Address - Fax:434-239-2204
Practice Address - Street 1:8116 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2608
Practice Address - Country:US
Practice Address - Phone:434-239-2651
Practice Address - Fax:434-239-2204
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010087401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice