Provider Demographics
NPI:1780705269
Name:ROBERTSON, FATIMA (DDS)
Entity type:Individual
Prefix:DR
First Name:FATIMA
Middle Name:
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 1:915 W EXCHANGE PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-7017
Mailing Address - Country:US
Mailing Address - Phone:214-509-9011
Mailing Address - Fax:469-519-0124
Practice Address - Street 1:915 W EXCHANGE PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7017
Practice Address - Country:US
Practice Address - Phone:214-509-9011
Practice Address - Fax:469-519-0124
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics