Provider Demographics
NPI:1598018608
Name:ROBERTSON, HEATH ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:ANTHONY
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 1:720 EAST MAIN ST
Mailing Address - Street 2:PO BOX 789
Mailing Address - City:ADAMSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38310
Mailing Address - Country:US
Mailing Address - Phone:731-632-4754
Mailing Address - Fax:731-632-4770
Practice Address - Street 1:720 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:ADAMSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38310
Practice Address - Country:US
Practice Address - Phone:731-632-4754
Practice Address - Fax:731-632-4770
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist