Provider Demographics
NPI:1376648600
Name:ROBERTSON-CAMERON, STEPHANIE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANNE
Last Name:ROBERTSON-CAMERON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2434 N WOODLAWN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3959
Mailing Address - Country:US
Mailing Address - Phone:316-685-0267
Mailing Address - Fax:316-651-5040
Practice Address - Street 1:2434 N WOODLAWN
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3959
Practice Address - Country:US
Practice Address - Phone:316-685-0267
Practice Address - Fax:316-651-5040
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS67901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6790OtherKS DENTAL BOARD DENTAL