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General NPI Number Information
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NPI Number | 1881347235
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Entity Type | Organization
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Legal Business Name | ROBERSON FAMILY DENTAL, INC
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Dates
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Enumeration Date | 01/26/2022
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Last Update Date | 01/26/2022
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Provider Practice Location Address
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Address Line | 324 29TH ST
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City | HUNTINGTON
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State | WV
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Zip | 25702-1428
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Country | US
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Telephone | 304-523-2790
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Fax |
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Provider Business Mailing Address
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Address Line | 324 29TH ST
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City | HUNTINGTON
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State | WV
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Zip | 25702-1428
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Country | US
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Telephone | 304-523-2790
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. KENNETH JAMES ROBERSON
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Credential | DDS
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Telephone | 304-539-0876
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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 |
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License Number State |
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