Provider Demographics
NPI:1386874691
Name:ROBERTS, JOYCE MONIQUE (DMD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:MONIQUE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-1405
Mailing Address - Country:US
Mailing Address - Phone:706-339-2705
Mailing Address - Fax:
Practice Address - Street 1:615 W OGLETHORPE HWY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4485
Practice Address - Country:US
Practice Address - Phone:912-877-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist