NPIMap

Organization Active NPI

Charles W Roberts IV DDS & Kari L Lundberg DDS PA

  • Dentist
  • Mooresville, NC
National Provider Identifier
1801962196
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7023 Issued in NC
Legal business name
CHARLES W ROBERTS IV DDS & KARI L LUNDBERG DDS PA
Practice address
142 Professional Park Dr
Suite 100 & 200
Mooresville, NC 28117
Phone
(704) 663-1234
Fax
(704) 663-7912
NPI assigned
Nov 28, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Charles Waitsel Roberts IV, DDSNPI 1003021908
Title
Dentist
Phone
(704) 664-5437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 7023 NC Primary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 7002 NC

Addresses

Primary practice location

142 Professional Park Dr
Suite 100 & 200
Mooresville, NC 28117

Mailing address

142 Professional Park Dr
Suite 100 & 200
Mooresville, NC 28117
Phone (704) 663-1234

Other identifiers 2

IdentifierTypeStateIssuer
5902375MedicaidNC
902E8OtherNCHEALTH CHOICE

National Provider Directory

National Provider Directory

Locations

142 Professional Park Dr
Ste 100
Mooresville, NC 28117
Phone (704) 663-1234

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801962196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "142 PROFESSIONAL PARK DR",
            "address_2": "SUITE 100 & 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28117",
            "telephone_number": "704-663-1234",
            "fax_number": "704-663-7912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 PROFESSIONAL PARK DR",
            "address_2": "SUITE 100 & 200",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "28117",
            "telephone_number": "704-663-1234",
            "fax_number": "704-663-7912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES W ROBERTS IV DDS & KARI L LUNDBERG DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "WAITSEL",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "704-664-5437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "7023",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "NC",
            "license": "7002",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902375",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH CHOICE",
            "identifier": "902E8",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.