Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS042900 | PA |
NPI | 1740893791 |
---|---|
Provider Name | Trent William Roberts |
First Address | Pittsburgh, PA 15217-3148 |
Second Address | Pittsburgh, PA 15220-2921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |