Dr Jon M. Roberts Family Dentistry PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

DR JON M. ROBERTS FAMILY DENTISTRY PC

Practice address

2320 Northpark Suite C.
Columbus, IN 47203-4482

Phone

(812) 379-9561

Fax

(812) 372-8157

NPI assigned

Jun 29, 2015

Last updated

Jun 29, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jon M. Roberts

Title

President/Dentist

Phone

(812) 379-9561

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435536000000",
    "number": "1952783722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2320 NORTHPARK SUITE C.",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472034482",
            "telephone_number": "812-379-9561",
            "fax_number": "812-372-8157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 NORTHPARK SUITE C.",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472034482",
            "telephone_number": "812-379-9561",
            "fax_number": "812-372-8157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR JON M. ROBERTS FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-29",
        "last_updated": "2015-06-29",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "812-379-9561",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100052120A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Columbus, IN
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; 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.