David Roberts, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11295 Issued in OR

Practice address

112 NE 5TH Ave
Milton Freewater, OR 97862-1704

Phone

(541) 809-7043

Fax

(541) 516-4046

NPI assigned

Oct 15, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1444867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1326419383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 NE 5TH AVE",
            "city": "MILTON FREEWATER",
            "state": "OR",
            "postal_code": "978621704",
            "telephone_number": "541-837-1699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 NE 5TH AVE",
            "city": "MILTON FREEWATER",
            "state": "OR",
            "postal_code": "978621704",
            "telephone_number": "541-809-7043",
            "fax_number": "541-516-4046"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 Town Centre Dr",
            "address_purpose": "LOCATION",
            "city": "Johnstown",
            "state": "PA",
            "postal_code": "159042824",
            "country_code": "US",
            "telephone_number": "866-965-6470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "DAVID",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-10-15",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60870688",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS040645",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Milton Freewater, OR
• Providers in Milton Freewater, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; 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.