| R Ted Roberts Dds Pa | |
|
632 Friars Point Road Clarksdale MS 38614 | |
| (662) 624-6862 | |
| (662) 624-5985 |
| Full Name | R Ted Roberts Dds Pa |
|---|---|
| Speciality | Dentist |
| Location | 632 Friars Point Road, Clarksdale, Mississippi |
| Authorized Official Name and Position | R Ted Roberts (PRESIDENT) |
| Authorized Official Contact | 6626246862 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| R Ted Roberts Dds Pa 632 Friars Point Road Clarksdale MS 38614 Ph: (662) 624-6862 | R Ted Roberts Dds Pa 632 Friars Point Road Clarksdale MS 38614 Ph: (662) 624-6862 |
| NPI Number | 1164524328 |
|---|---|
| Provider Enumeration Date | 09/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164524328 | NPI | - | NPPES |
| 03036322 | Medicaid | MS | |
| 00062287 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 147071 (Mississippi) | Primary |
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