NPIMap

Organization Active NPI

Roberts Family Dental, PC

  • Dentist
  • Decatur, GA
National Provider Identifier
1013086248
Registry record updated Sep 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN010168 Issued in GA
Legal business name
ROBERTS FAMILY DENTAL, PC
Practice address
3660 Flat Shoals Road
Suite 100
Decatur, GA 30034-1632
Phone
(404) 243-0217
Fax
(404) 243-9313
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2010

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

Authorized official

Name
Resa Johnelle Roberts
Title
Corporate Officer
Phone
(404) 556-1393

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DN010168 GA Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DN012459 GA
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X DN013502 GA
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223S0112X DN056718 GA
Dental HygienistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 124Q00000X DH007395 GA

Addresses

Primary practice location

3660 Flat Shoals Road
Suite 100
Decatur, GA 30034-1632

Mailing address

PO Box 370777
Decatur, GA 30037-0777
Phone (404) 243-0217

Other identifiers 1

IdentifierTypeStateIssuer
559391OtherGAUCCI - ROBERTS

National Provider Directory

National Provider Directory

Locations

3660 Flat Shoals Rd
Ste 100
Decatur, GA 30034
Phone (404) 243-0217

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285718400000",
    "number": "1013086248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370777",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300370777",
            "telephone_number": "404-243-0217",
            "fax_number": "678-904-4944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3660 FLAT SHOALS ROAD",
            "address_2": "SUITE 100",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300341632",
            "telephone_number": "404-243-0217",
            "fax_number": "404-243-9313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTS FAMILY DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2010-09-29",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "RESA",
        "authorized_official_middle_name": "JOHNELLE",
        "authorized_official_title_or_position": "CORPORATE OFFICER",
        "authorized_official_telephone_number": "404-556-1393"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN010168",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN012459",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN013502",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN056718",
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": "GA",
            "license": "DH007395",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCCI - ROBERTS",
            "identifier": "559391",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; 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.