Roberts, Wallace & Associates PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9846 Issued in NC

Legal business name

ROBERTS, WALLACE & ASSOCIATES PLLC

Practice address

2643 Randleman Rd
Greensboro, NC 27406-5153

Phone

(336) 544-2758

Fax

(910) 338-3031

NPI assigned

May 24, 2018

Organization subpart

No

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

Addresses

Other identifiers 1

Other names 1

• Triad Kids Dental Doing business as

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.

• Roberts, Wallace & Associates PLLC

  • General Practice Dentistry
  • Winston Salem, NC
  • NPI 1104203579
  NPD tax ID
• Roberts, Wallace & Associates PLLC

  • General Practice Dentistry
  • Greensboro, NC
  • NPI 1104218007
  NPD tax ID

Locations

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755216000000",
    "number": "1578054557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2643 RANDLEMAN RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274065153",
            "telephone_number": "480-866-8811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2643 RANDLEMAN RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274065153",
            "telephone_number": "336-544-2758",
            "fax_number": "910-338-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTS, WALLACE & ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-24",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689746232",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Triad Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Triad Kids Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Lynn Roberts, M.A.
• Ronald Wayne Roberts, MD
• Serena Roberts, PHARMD
• Valencia Roberts
• Roberts, Wallace & Associates PLLC
• Andrew Robertson, PHARMD
• Brooke Robertson, RN
• Carolyn Thomas Robertson, RN
• Christopher Robertson, M.A.
• Denise T Robertson, PTA

• General Practice Dentistry in Greensboro, NC
• Providers in Greensboro, NC by specialty
• General Practice Dentistry in North Carolina

• 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.