Provider Demographics
NPI:1871571463
Name:ROBERSON, PATRICK MCQUOWN (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MCQUOWN
Last Name:ROBERSON
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 1:1407 HILLSBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1828
Mailing Address - Country:US
Mailing Address - Phone:919-834-1432
Mailing Address - Fax:919-977-3102
Practice Address - Street 1:1407 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1828
Practice Address - Country:US
Practice Address - Phone:919-834-1432
Practice Address - Fax:919-977-3102
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FEDERAL DEAOtherBR9146728