Provider Demographics
NPI:1003205535
Name:ROBERTSON DENTAL PLLC
Entity type:Organization
Organization Name:ROBERTSON DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-471-5831
Mailing Address - Street 1:105 HUDSON DR
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2801
Mailing Address - Country:US
Mailing Address - Phone:301-471-5831
Mailing Address - Fax:
Practice Address - Street 1:105 HUDSON DR
Practice Address - Street 2:SUITE 9B
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2801
Practice Address - Country:US
Practice Address - Phone:301-471-5831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty