Provider Demographics
NPI:1861719957
Name:ROBERTSON, BELINDA KAY (RDH)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:KAY
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:BELINDA
Other - Middle Name:KAY
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:516 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-8334
Mailing Address - Country:US
Mailing Address - Phone:660-665-5576
Mailing Address - Fax:
Practice Address - Street 1:302 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3416
Practice Address - Country:US
Practice Address - Phone:660-626-2741
Practice Address - Fax:660-626-2188
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2207016324124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist