Provider Demographics
NPI:1336368786
Name:ROBERTSON, DON C (DDS)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:C
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 1:8325 S. DEAD BEAR DRAW
Mailing Address - Street 2:
Mailing Address - City:HEREFORE
Mailing Address - State:AZ
Mailing Address - Zip Code:85615
Mailing Address - Country:US
Mailing Address - Phone:520-803-9366
Mailing Address - Fax:
Practice Address - Street 1:2151 S. HWY 92, SUITE 103
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-417-0311
Practice Address - Fax:520-417-0299
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD17321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics