Micah A Roberts, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019029023 Issued in IL

Practice address

4517 N Rockwood Dr
Peoria, IL 61615-3841

Phone

(309) 693-0043

Fax

(309) 688-5643

NPI assigned

Jun 25, 2012

Last updated

Oct 6, 2020By 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

Medicare enrollment (NPD)

Not enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Peoria Dental Care

  • Dental Clinic/Center
  • Peoria, IL
  • NPI 1851909345
  NPD

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

{
    "created_epoch": "1340582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1760746747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4517 N ROCKWOOD DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616153841",
            "telephone_number": "309-688-0121",
            "fax_number": "309-688-5643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4517 N ROCKWOOD DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616153841",
            "telephone_number": "309-693-0043",
            "fax_number": "309-688-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MICAH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-25",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.029023",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019029023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brad Roberts, DO
• Dawn C Roberts, PHD
• Jeffrey B Roberts, P.A.
• Jennifer Sue Roberts, D.O.
• Jonathan Charles Roberts, M.D.
• Shannon Marie Roberts, APRN
• Sarah Katherine Robertson, MA
• John Michael Robins, MD
• Jenay E Robinson, AS. BS.
• Ryan T Robinson, MD

• General Practice Dentistry in Peoria, IL
• Providers in Peoria, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; 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.