Active NPI
Charles A Roberts, DDS
- Dentist
- Kailua Kona, HI
National Provider Identifier
1275774952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1065
- Practice address
- 75-1028 Henry St
Ste. 203
Kailua Kona, HI 96740-1693 - Phone
- (808) 329-4425
- Fax
- (808) 329-0872
- NPI assigned
- Mar 10, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1065 | HI | Primary |
Addresses
Primary practice location
75-1028 Henry St
Ste. 203
Kailua Kona, HI 96740-1693
Mailing address
555 W Benjamin Holt Dr
BLDG. B
Stockton, CA 95207-3839
Phone (209) 476-4700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1065 | HI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236643200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236643200000",
"number": "1275774952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 W BENJAMIN HOLT DR",
"address_2": "BLDG. B",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952073839",
"telephone_number": "209-476-4700",
"fax_number": "209-478-6890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75-1028 HENRY ST",
"address_2": "STE. 203",
"city": "KAILUA KONA",
"state": "HI",
"postal_code": "967401693",
"telephone_number": "808-329-4425",
"fax_number": "808-329-0872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "CHARLES",
"middle_name": "A",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-03-10",
"last_updated": "2009-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "HI",
"license": "1065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kailua Kona, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.