Provider Demographics
NPI:1336030113
Name:ROBERTSON, GARRETT S (DDS)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:S
Last Name:ROBERTSON
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 1:920 W VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-9466
Mailing Address - Country:US
Mailing Address - Phone:304-531-8912
Mailing Address - Fax:304-239-0996
Practice Address - Street 1:1628 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3007
Practice Address - Country:US
Practice Address - Phone:304-236-2366
Practice Address - Fax:304-239-0996
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4803122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist