Provider Demographics
NPI:1528276870
Name:ROBERTS-LAGRANGE, MIA DANIELLE' (DDS)
Entity type:Individual
Prefix:DR
First Name:MIA
Middle Name:DANIELLE'
Last Name:ROBERTS-LAGRANGE
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 1:732 HEATHER KNOLL DR.
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115
Mailing Address - Country:US
Mailing Address - Phone:972-230-1575
Mailing Address - Fax:
Practice Address - Street 1:732 HEATHER KNOLL DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4612
Practice Address - Country:US
Practice Address - Phone:972-230-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice