Roberts, Wallace & Associates PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9846 Issued in NC

Legal business name

ROBERTS, WALLACE & ASSOCIATES PLLC

Practice address

5069 University Pkwy # 11
Winston Salem, NC 27106-6083

Phone

(336) 714-5726

Fax

(336) 792-4202

NPI assigned

May 5, 2015

Organization subpart

No

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

Authorized official

Name

Teresa Zwicky

Title

Credentialing Manager

Phone

(480) 866-8811

Specialties & licenses 1

Addresses

Other names 1

• Triad Kids Dental Doing business as

Tax ID family

Roberts Wallace Associates PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Roberts, Wallace & Associates PLLC

  • General Practice Dentistry
  • Greensboro, NC
  • NPI 1104218007
  NPD tax ID
• Roberts, Wallace & Associates PLLC

  • General Practice Dentistry
  • Greensboro, NC
  • NPI 1578054557
  NPD tax ID

Locations

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

{
    "created_epoch": "1430784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755216000000",
    "number": "1104203579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5069 UNIVERSITY PKWY",
            "address_2": "11",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271066083",
            "telephone_number": "336-714-5726",
            "fax_number": "336-792-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5069 UNIVERSITY PKWY # 11",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271066083",
            "telephone_number": "336-714-5726",
            "fax_number": "336-792-4202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTS, WALLACE & ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-05",
        "last_updated": "2025-08-15",
        "certification_date": "2025-08-15",
        "status": "A",
        "authorized_official_last_name": "ZWICKY",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "480-866-8811"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "9846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Triad Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer L Roberts, M.D.
• Kayla Roberts
• Kiyra Shanice Roberts
• Kyle Timothy Roberts, PA
• Rodrike Quentrell Roberts, DNP, FNP-BC
• Amber Robertson
• Angeline Louise Robertson, NP
• Charlie Martin Robertson III, CRNA
• Chelsie Adrianna Renee Robertson
• Kailey Robertson

• General Practice Dentistry in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2025; 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.