Provider Demographics
NPI:1508984212
Name:ROBERTSON, DAVID PRINCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PRINCE
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 1:3002 BRIDGES ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3330
Mailing Address - Country:US
Mailing Address - Phone:252-726-1461
Mailing Address - Fax:252-726-2935
Practice Address - Street 1:3002 BRIDGES ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3330
Practice Address - Country:US
Practice Address - Phone:252-726-1461
Practice Address - Fax:252-726-2935
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997416Medicaid
NC8997416Medicaid