Provider Demographics
NPI:1467555086
Name:ROBERTSON, RANDY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:M
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:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621
Mailing Address - Country:US
Mailing Address - Phone:512-281-4260
Mailing Address - Fax:512-285-3229
Practice Address - Street 1:1309 N AVE C
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621
Practice Address - Country:US
Practice Address - Phone:512-281-4260
Practice Address - Fax:512-285-3229
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist