Charles Waitsel Roberts IV, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

7023 Issued in NC

Practice address

142 Professional Park Dr
Suite 200
Mooresville, NC 28117-5537

Phone

(704) 664-5437

Fax

(704) 663-7912

NPI assigned

May 14, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1003021908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 PROFESSIONAL PARK DR",
            "address_2": "SUITE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175537",
            "telephone_number": "704-664-5437",
            "fax_number": "704-663-7912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 PROFESSIONAL PARK DR",
            "address_2": "SUITE 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281175537",
            "telephone_number": "704-664-5437",
            "fax_number": "704-663-7912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "CHARLES",
        "middle_name": "WAITSEL",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-14",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NC",
            "license": "7023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902375",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassie Robacker, BCBA
• Sherri Robbins, LCMHC, LCPC
• Misty Roberson
• Robert C. Gray Jr., DDS, P.a.
• Catherine Ann Roberts, NP
• Christopher Michael Roberts, LCMHC, NCC
• Kimberly Roberts
• Angela Kay Robertson-Turner, FNP
• Hillary Ann Robinowitz-Elins, M.D.
• James Alexander Robinson, D.P.M.

• Pediatric Dentistry in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Pediatric Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.