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Contact Information

R TED ROBERTS DDS PA
632 FRIARS POINT ROAD
CLARKSDALE, MS38614
 Phone: 662-624-6862
 Fax: 662-624-5985
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dentist

122300000X
Indicates primary specialty

NPI Profile & details for R TED ROBERTS DDS PA

NPI Number 1164524328
LBN Legal business name R TED ROBERTS DDS PA
Authorized official R ROBERTS - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 09/01/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
MS License # 147071
MS Medicaid 00062287
MS Medicaid 03036322
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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