Provider Demographics
NPI:1538685060
Name:ROBERTSON, ANNA THERESE (IPDH)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:THERESE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:IPDH
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 1898
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-1898
Mailing Address - Country:US
Mailing Address - Phone:207-469-2912
Mailing Address - Fax:207-469-6370
Practice Address - Street 1:154 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416
Practice Address - Country:US
Practice Address - Phone:207-469-2912
Practice Address - Fax:207-469-6370
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3123124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI$$$$$$$$$OtherSS NUMBER