| Dr. Tony Roberts D.d.s. Llc | |
|
517 W 5th St Ste 106 Pueblo CO 81003-3185 | |
| (719) 542-6014 | |
| (719) 583-7937 |
| Full Name | Dr. Tony Roberts D.d.s. Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 517 W 5th St, Pueblo, Colorado |
| Authorized Official Name and Position | Tony Leon Roberts (MANAGING MEMBER) |
| Authorized Official Contact | 7195426014 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Tony Roberts D.d.s. Llc 5623 Terracina Pl Pueblo CO 81005-5582 Ph: (719) 542-6014 | Dr. Tony Roberts D.d.s. Llc 517 W 5th St Ste 106 Pueblo CO 81003-3185 Ph: (719) 542-6014 |
| NPI Number | 1871777136 |
|---|---|
| Provider Enumeration Date | 12/21/2007 |
| Last Update Date | 08/09/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871777136 | NPI | - | NPPES |
| 02052025 | Medicaid | CO | |
| 46201751 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 105202 (Colorado) | Primary |
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