Provider Demographics
NPI:1083849715
Name:ROBERTSON, PAUL LAMONT (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:LAMONT
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 1:126 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3915
Mailing Address - Country:US
Mailing Address - Phone:515-576-6500
Mailing Address - Fax:515-576-1951
Practice Address - Street 1:126 N 10TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-3915
Practice Address - Country:US
Practice Address - Phone:515-576-6500
Practice Address - Fax:515-576-1951
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist