Provider Demographics
NPI:1710116041
Name:ROBERSON, JEFFREY BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:ROBERSON
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 1:1222 SCOTS FIELD CT
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2654
Mailing Address - Country:US
Mailing Address - Phone:801-699-9219
Mailing Address - Fax:
Practice Address - Street 1:9217 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5826
Practice Address - Country:US
Practice Address - Phone:801-566-1873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7368949-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist