Provider Demographics
NPI:1689671760
Name:ROBERTSON, CLAUDE K (DDS)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:K
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DDS
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 1860
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-1860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 CENTER ST. E.
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328-1860
Practice Address - Country:US
Practice Address - Phone:360-832-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000038511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA229389OtherCIGNA INSURANCE
WARO2486OtherBLUE CROSS INSURANCE
WA342147OtherUNITED CONCORDIA INS.
WA5355508Medicaid
WA957OtherWA DENTAL INSURANCE