Provider Demographics
NPI:1861097107
Name:BRIAN B ROBERTS DDS PLC
Entity type:Organization
Organization Name:BRIAN B ROBERTS DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-309-4709
Mailing Address - Street 1:4365 E PECOS RD STE 137
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8053
Mailing Address - Country:US
Mailing Address - Phone:480-507-1943
Mailing Address - Fax:480-988-0203
Practice Address - Street 1:4365 E PECOS RD STE 137
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-8053
Practice Address - Country:US
Practice Address - Phone:480-507-1943
Practice Address - Fax:480-988-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Single Specialty