Provider Demographics
NPI:1740294768
Name:ROBERTSON, JOSEPH WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
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 1:1551 W BIG BEAVER RD
Mailing Address - Street 2:STE D-14
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3528
Mailing Address - Country:US
Mailing Address - Phone:248-643-7530
Mailing Address - Fax:248-643-7533
Practice Address - Street 1:1551 W BIG BEAVER RD
Practice Address - Street 2:STE D-14
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3528
Practice Address - Country:US
Practice Address - Phone:248-643-7530
Practice Address - Fax:248-643-7533
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI138101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice