NPIMap

Organization Active NPI

Roberts, Wallace & Associates PLLC

  • General Practice Dentistry
  • Greensboro, NC
National Provider Identifier
1104218007
Registry record updated Aug 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9846 Issued in NC
Legal business name
ROBERTS, WALLACE & ASSOCIATES PLLC
Practice address
510 Nicholas Rd Ste F
Greensboro, NC 27409-3404
Phone
(336) 387-9168
NPI assigned
Mar 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 9846 NC Primary

Addresses

Primary practice location

510 Nicholas Rd Ste F
Greensboro, NC 27409-3404

Mailing address

510 Nicholas Rd
F
Greensboro, NC 27409-3399

Other names 1

  • Triad Kids Dental Doing business as

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755216000000",
    "number": "1104218007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 NICHOLAS RD",
            "address_2": "F",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274093399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 NICHOLAS RD STE F",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274093404",
            "telephone_number": "336-387-9168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTS, WALLACE & ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-02",
        "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"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • 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.