Thomas Blake Roberts, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10610 Issued in KY

Practice address

4616 Village Square Dr
Paducah, KY 42001-7501

Phone

(270) 444-6080

NPI assigned

May 21, 2021

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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 and National Provider Directory roles.

• Freeman Dental

  • Dentist
  • Mayfield, KY
  • NPI 1265803886
  NPD (past)
• Freeman Dental PLLC

  • Dentist
  • Mayfield, KY
  • NPI 1437535119
  NPD (past)

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1689249872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4616 VILLAGE SQUARE DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420017501",
            "telephone_number": "270-444-6080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4616 VILLAGE SQUARE DR",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420017501",
            "telephone_number": "270-444-6080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "312 Wyatt Dr",
            "address_purpose": "LOCATION",
            "city": "Mayfield",
            "state": "KY",
            "postal_code": "420666810",
            "country_code": "US",
            "telephone_number": "270-247-1966",
            "fax_number": "270-247-5471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "THOMAS",
        "middle_name": "BLAKE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-21",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "10610",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John M. Roach, M.D
• Rachel Roach
• Bradley Robbins, PT, DPT
• Lindsey Brooke Roberts, APRN, FNP-C
• Lowell F Roberts, M.D.
• Tiffany H Roberts, OT
• Vicki Lynn Roberts, MD
• John Lever Robertson, RPH
• Kevin Robertson
• Joan Anita Robinson, M.D.

• General Practice Dentistry in Paducah, KY
• Providers in Paducah, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; 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.