Provider Demographics
NPI:1891996831
Name:ROBERTSON, DONALD BRUCE (PERIODONTIST)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BRUCE
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PERIODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 N 7TH AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1158
Mailing Address - Country:US
Mailing Address - Phone:602-242-2588
Mailing Address - Fax:602-242-3137
Practice Address - Street 1:6520 N 7TH AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1158
Practice Address - Country:US
Practice Address - Phone:602-242-2588
Practice Address - Fax:602-242-3137
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD12741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics