Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 12006554A | IN |
NPI | 1558450346 |
---|---|
Provider Name | Dr. James A Roberts |
First Address | Auburn, IN 46706 |
Second Address | Auburn, IN 46706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |