Provider Demographics
NPI:1154597151
Name:ROBERTS, KRISTN D (DDS)
Entity type:Individual
Prefix:
First Name:KRISTN
Middle Name:D
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 1:490 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1762
Mailing Address - Country:US
Mailing Address - Phone:540-483-5241
Mailing Address - Fax:540-484-1121
Practice Address - Street 1:490 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1762
Practice Address - Country:US
Practice Address - Phone:540-483-5241
Practice Address - Fax:540-484-1121
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0400087681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice