MEDICARE: DR. STEVEN DEREK ROBERTSON D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10934	NC

General Provider Information

NPI Number	:	1538518840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN DEREK ROBERTSON D.M.D.

Provider Business Mailing Address
First Line	:	1613 MONTFORD DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3702
Country	:	US
Telephone Number	:	704-523-0551
Fax Number	:	704-525-6753

Provider Business Practice Location Address
First Line	:	1613 MONTFORD DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3702
Country	:	US
Telephone Number	:	704-523-0551
Fax Number	:	704-525-6753

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	09/26/2019

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