Justin L Roberts, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12012271A Issued in IN

Practice address

3415 S Lafountain St Ste I
Kokomo, IN 46902-3826

Phone

(765) 455-1222

Fax

(765) 455-0485

NPI assigned

Apr 8, 2011

Sex

Male

Sole proprietor

Yes

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

Enrolled in IN

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Roberts Dental Group LLC

  • General Practice Dentistry
  • Kokomo, IN
  • NPI 1811601800
  NPD Authorized official

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

{
    "created_epoch": "1302220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608595200000",
    "number": "1699065862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10450 E 500 S",
            "city": "KIRKLIN",
            "state": "IN",
            "postal_code": "460508800",
            "telephone_number": "317-850-2327",
            "fax_number": "765-455-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 S LAFOUNTAIN ST STE I",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469023826",
            "telephone_number": "765-455-1222",
            "fax_number": "765-455-0485"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "118 S Green St",
            "address_purpose": "LOCATION",
            "city": "Greentown",
            "state": "IN",
            "postal_code": "469361411",
            "country_code": "US",
            "telephone_number": "765-455-1222",
            "fax_number": "765-455-0485",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "138 Shawnee St",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "OH",
            "postal_code": "453312529",
            "country_code": "US",
            "telephone_number": "937-547-0114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JUSTIN",
        "middle_name": "L",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-08",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12012271A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cale Roark
• Samantha Dawn Roark
• Robert a. Clements, D.C., P.C.
• Roberts Dental Group LLC
• Amanda Roberts, PMHNP
• Lindsey Carol Roberts, FNP
• Paul Joseph Roberts, PH.D.
• Lori Annette Robertson, LCSW, LCAC
• James Robinson, RPT
• Makayla Lee Robison

• Dentist in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.