Provider Demographics
NPI:1003275645
Name:DARYL ROBERTSON DDS PA
Entity Type:Organization
Organization Name:DARYL ROBERTSON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-274-2285
Mailing Address - Street 1:101 N MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4015
Mailing Address - Country:US
Mailing Address - Phone:806-274-2285
Mailing Address - Fax:806-274-5733
Practice Address - Street 1:101 N MCGEE ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4015
Practice Address - Country:US
Practice Address - Phone:806-274-2285
Practice Address - Fax:806-274-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty