Provider Demographics
NPI:1699857524
Name:ROBERTS, RICHARD B (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8077 LA MESA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-6434
Mailing Address - Country:US
Mailing Address - Phone:619-465-8077
Mailing Address - Fax:619-463-4943
Practice Address - Street 1:8077 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-6434
Practice Address - Country:US
Practice Address - Phone:619-465-8077
Practice Address - Fax:619-463-4943
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice