Provider Demographics
NPI:1992143044
Name:ROBERTS, ANNA ELISE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:ELISE
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 1:611 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-5208
Mailing Address - Country:US
Mailing Address - Phone:540-951-8383
Mailing Address - Fax:
Practice Address - Street 1:611 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-5208
Practice Address - Country:US
Practice Address - Phone:540-951-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-414042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist