Provider Demographics
NPI:1184829715
Name:ROBERTSON, ALISON RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:RAE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50841 STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8268
Mailing Address - Country:US
Mailing Address - Phone:317-874-6885
Mailing Address - Fax:
Practice Address - Street 1:236 SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46516-4671
Practice Address - Country:US
Practice Address - Phone:574-970-1937
Practice Address - Fax:574-970-1939
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011017A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist