Provider Demographics
NPI:1700912292
Name:ROBERSON, THEODORE MILTON II (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:MILTON
Last Name:ROBERSON
Suffix:II
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 1:340 DABNEY DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-4036
Mailing Address - Country:US
Mailing Address - Phone:252-492-0073
Mailing Address - Fax:252-492-0359
Practice Address - Street 1:340 DABNEY DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-4036
Practice Address - Country:US
Practice Address - Phone:252-492-0073
Practice Address - Fax:252-492-0359
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice