Kenneth Wayne Roberts, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901013871 Issued in MI

Practice address

546 N Lafayette St
South Lyon, MI 48178-2000

Phone

(248) 486-1730

Fax

(248) 486-9544

NPI assigned

Apr 20, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kenneth W Roberts, DDS, PC

  • Dentist
  • South Lyon, MI
  • NPI 1326592312
  NPD (past) Authorized official
• Natasha Gates DDS, PLLC

  • Dental Clinic/Center
  • South Lyon, MI
  • NPI 1245712199
  NPD (past)

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124245006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "546 N LAFAYETTE ST",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481782000",
            "telephone_number": "248-486-1730",
            "fax_number": "248-486-9544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "546 N LAFAYETTE ST",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481782000",
            "telephone_number": "248-486-1730",
            "fax_number": "248-486-9544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "KENNETH",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901013871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Jim Rigney, DDS
• Rite Aid of Michigan Inc
• Teresa Wilson Rittinger, LLMFT
• Noah Rivera
• RJ Club LLC
• Bret Eric Robertson, RPH
• Wendy Robinson
• Pierre Rojas, D.O.
• Root and Rise Pelvic Health Physical Therapy PLLC
• Christian William Roth, PT, CHT

• General Practice Dentistry in South Lyon, MI
• Providers in South Lyon, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.