Provider Demographics
NPI:1013036722
Name:ROBERTSON, ROXANNE G (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:G
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DDS MS
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Mailing Address - Street 1:4750 S PADRE ISLAND DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4416
Mailing Address - Country:US
Mailing Address - Phone:361-992-2483
Mailing Address - Fax:361-986-7175
Practice Address - Street 1:4750 S PADRE ISLAND DR STE 101
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4416
Practice Address - Country:US
Practice Address - Phone:361-992-2483
Practice Address - Fax:361-986-7175
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD176611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics