Provider Demographics
NPI:1003864653
Name:ROBERTSON, TOM MARVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:MARVIN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:MARVIN
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:12727 KIMBERLEY LN
Mailing Address - Street 2:#203
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4047
Mailing Address - Country:US
Mailing Address - Phone:713-464-1544
Mailing Address - Fax:713-464-1530
Practice Address - Street 1:12727 KIMBERLEY LN
Practice Address - Street 2:#203
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4047
Practice Address - Country:US
Practice Address - Phone:713-464-1544
Practice Address - Fax:713-464-1530
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist