Provider Demographics
NPI:1356411920
Name:ROBERTSON, JEANNETTE ZAYKEEAH (DDS)
Entity type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:ZAYKEEAH
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 E STONY HILL CT APT 2A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6838
Mailing Address - Country:US
Mailing Address - Phone:973-809-5507
Mailing Address - Fax:
Practice Address - Street 1:13516 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2107
Practice Address - Country:US
Practice Address - Phone:804-293-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0133131223S0112X
VA04380004771223S0112X
TN49053851223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery