Jared D Roberts, D.D.S

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D008914 Issued in AZ

Practice address

1751 W Orange Grove Rd
Suite 101
Tucson, AZ 85704-1192

Phone

(520) 742-4227

Fax

(520) 742-4892

NPI assigned

Oct 10, 2011

Last updated

Jun 8, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective May 20, 2015 through May 20, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Wayne K. Goodner, D.D.S., P.C.

  • Dentist
  • Tucson, AZ
  • NPI 1386654317
  NPD (past)

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

{
    "created_epoch": "1318204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433721600000",
    "number": "1366726234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1751 W ORANGE GROVE RD",
            "address_2": "SUITE 101",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857041192",
            "telephone_number": "520-742-4227",
            "fax_number": "520-742-4892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1751 W ORANGE GROVE RD",
            "address_2": "SUITE 101",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857041192",
            "telephone_number": "520-742-4227",
            "fax_number": "520-742-4892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JARED",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-10",
        "last_updated": "2015-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "UT",
            "license": "80275999922",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "AZ",
            "license": "D008914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexia Roberts-Derego
• Aaron Roberts, MD
• Bernice Roberts, DO
• Charles E. Roberts, D.D.S.
• Christina Roberts, PTA
• Jasmien Roberts, MD
• Jeffrey Roberts, DMD
• Jennafer Roberts
• Jenny Lynn Roberts, FNP-C
• Kara E Roberts, ACNP-BC

• Periodontics in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Periodontics in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.