MEDICARE: DR. TOM 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	122300000X	Dentist	11450	TX

General Provider Information

NPI Number	:	1003864653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOM MARVIN ROBERTSON D.D.S.

Provider Business Mailing Address
First Line	:	12727 KIMBERLEY LN
Second Line	:	#203
City	:	HOUSTON
State	:	TX
Zip	:	77024-4047
Country	:	US
Telephone Number	:	713-464-1544
Fax Number	:	713-464-1530

Provider Business Practice Location Address
First Line	:	12727 KIMBERLEY LN
Second Line	:	#203
City	:	HOUSTON
State	:	TX
Zip	:	77024-4047
Country	:	US
Telephone Number	:	713-464-1544
Fax Number	:	713-464-1530

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	03/30/2017

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