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General NPI Number Information
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NPI Number | 1710116041
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Entity Type | Individual
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Provider Name | JEFFREY BRIAN ROBERSON DDS
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Gender | Male
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 9217 S REDWOOD RD
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City | WEST JORDAN
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State | UT
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Zip | 84088-5826
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Country | US
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Telephone | 801-566-1873
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Fax |
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Provider Business Mailing Address
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Address Line | 1222 SCOTS FIELD CT
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City | MURRAY
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State | UT
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Zip | 84123-2654
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Country | US
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Telephone | 801-699-9219
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7368949-9922
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License Number State | UT
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