Provider Demographics
NPI:1366726234
Name:ROBERTS, JARED D (DDS)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:D
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 W ORANGE GROVE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1192
Mailing Address - Country:US
Mailing Address - Phone:520-742-4227
Mailing Address - Fax:520-742-4892
Practice Address - Street 1:1751 W ORANGE GROVE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1192
Practice Address - Country:US
Practice Address - Phone:520-742-4227
Practice Address - Fax:520-742-4892
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT802759999221223P0300X
AZD0089141223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics