Provider Demographics
NPI:1043282007
Name:ROBERTON, DENNIS JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JOHN
Last Name:ROBERTON
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 1:2776 RINGGOLD ROAD
Mailing Address - Street 2:USA DENTAL ACTIVITY
Mailing Address - City:FT. SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503
Mailing Address - Country:US
Mailing Address - Phone:580-442-3905
Mailing Address - Fax:580-442-4002
Practice Address - Street 1:2776 RINGGOLD ROAD
Practice Address - Street 2:USA DENTAL ACTIVITY
Practice Address - City:FT. SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-442-3905
Practice Address - Fax:580-442-4002
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000056741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice