MEDICARE: DR. JAMES MARVIN ROBERTSON D.D.S.

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	12147	MI

General Provider Information

NPI Number	:	1003820986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES MARVIN ROBERTSON D.D.S.

Provider Business Mailing Address
First Line	:	369 E CHICAGO ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-2002
Country	:	US
Telephone Number	:	517-279-2943
Fax Number	:

Provider Business Practice Location Address
First Line	:	369 E CHICAGO ST
Second Line	:
City	:	COLDWATER
State	:	MI
Zip	:	49036-2002
Country	:	US
Telephone Number	:	517-279-7943
Fax Number	:

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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