Provider Demographics
NPI:1639259567
Name:ROBESON, GEORGE ALLAN III (DMD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALLAN
Last Name:ROBESON
Suffix:III
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 1:3379 OLIVE LANE
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003
Mailing Address - Country:US
Mailing Address - Phone:515-834-2577
Mailing Address - Fax:
Practice Address - Street 1:4090 WESTOWN PKWY STE A4
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6760
Practice Address - Country:US
Practice Address - Phone:515-223-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics