Provider Demographics
NPI:1538518840
Name:ROBERTSON, STEVEN DEREK (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DEREK
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 MONTFORD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3702
Mailing Address - Country:US
Mailing Address - Phone:704-523-0551
Mailing Address - Fax:704-525-6753
Practice Address - Street 1:1613 MONTFORD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3702
Practice Address - Country:US
Practice Address - Phone:704-523-0551
Practice Address - Fax:704-525-6753
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC109341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice