Dr. J Keith Roberts
Pediatric Dentist
828 S Auto Mall Rd
Bloomington
, Indiana 47401-5430
Dr. J Keith Roberts
Pediatric Dentist
828 S Auto Mall Rd
Bloomington
, Indiana 47401-5430
(812) 333-6305
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About
Features
Specialties
- Pediatric Dentist
Languages spoken
- English
Location
First Address
- Dr. J Keith Roberts
- 828 S Auto Mall Rd
- Bloomington, IN
- Zip : 47401-5430
- Fax : (812) 333-6305
- Phone : (812) 333-5437
Second Address
- Dr. J Keith Roberts
- 828 S Auto Mall Rd
- Bloomington, IN
- Zip : 47401-5430
- Fax : (812) 333-6305
- Phone : (812) 333-5437
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0221X | Pediatric Dentist | 12005978A | IN |
National Provider Identifier
| NPI | 1063596633 |
|---|---|
| Provider Name | Dr. J Keith Roberts |
| First Address | Bloomington, IN 47401-5430 |
| Second Address | Bloomington, IN 47401-5430 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/10/2006 |
| Last Update Date | 04/09/2012 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 100060010 | (05) | IN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.