Dr. Tony Roberts D.D.S. LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

105202 Issued in CO

Legal business name

DR. TONY ROBERTS D.D.S. LLC

Practice address

517 W 5TH St
Ste 106
Pueblo, CO 81003-3185

Phone

(719) 542-6014

Fax

(719) 583-7937

NPI assigned

Dec 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Tony Leon Roberts, DDSNPI 1033118815

Title

Managing Member

Phone

(719) 542-6014

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tony Leon Roberts, D.D.S.

  • General Practice Dentistry
  • Pueblo, CO
  • NPI 1033118815
  NPD (past) Authorized official

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

{
    "created_epoch": "1198195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344470400000",
    "number": "1871777136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5623 TERRACINA PL",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810055582",
            "telephone_number": "719-542-6014",
            "fax_number": "719-583-7937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 W 5TH ST",
            "address_2": "STE 106",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033185",
            "telephone_number": "719-542-6014",
            "fax_number": "719-583-7937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. TONY ROBERTS D.D.S. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-21",
        "last_updated": "2012-08-09",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "TONY",
        "authorized_official_middle_name": "LEON",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "719-542-6014",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "105202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02052025",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "46201751",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dr Jill D Pollock PC
• Dr Tina L Skinner DDS Ms PC
• Dr. Aaron Ransome & Associates P.C.
• Dr. Robert C. Davis
• Dr. Thomas Autobee
• Cameran Ann Drake, O.D.
• Daniel Drake
• Jenni Corinne Drake, O.D.
• Jennifer Drake, LCSW
• Jordan Drake

• General Practice Dentistry in Pueblo, CO
• Providers in Pueblo, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2012; 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.