Provider Demographics
NPI:1801889084
Name:ROBERTSON, LONN D (DMD)
Entity type:Individual
Prefix:
First Name:LONN
Middle Name:D
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 MILL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4547
Mailing Address - Country:US
Mailing Address - Phone:541-746-6517
Mailing Address - Fax:541-741-8060
Practice Address - Street 1:528 MILL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4547
Practice Address - Country:US
Practice Address - Phone:541-746-6517
Practice Address - Fax:541-741-8060
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD58811223G0001X
AK5481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice