Provider Demographics
NPI:1639552730
Name:ROBERTSON, ELIZABETH HELENA (RDH, RDA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HELENA
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RDH, RDA
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:HELENA
Other - Last Name:INNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH, RDA
Mailing Address - Street 1:210 SAN MATEO RD
Mailing Address - Street 2:104
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-7111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 SAN MATEO RD
Practice Address - Street 2:104
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-7111
Practice Address - Country:US
Practice Address - Phone:650-727-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26846124Q00000X
CA72301126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No126800000XDental ProvidersDental Assistant