MEDICARE: DR. DENNIS JOHN ROBERTON DMD

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	DE00005674	WA

General Provider Information

NPI Number	:	1043282007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS JOHN ROBERTON DMD

Provider Business Mailing Address
First Line	:	2776 RINGGOLD ROAD
Second Line	:	USA DENTAL ACTIVITY
City	:	FT. SILL
State	:	OK
Zip	:	73503
Country	:	US
Telephone Number	:	580-442-3905
Fax Number	:	580-442-4002

Provider Business Practice Location Address
First Line	:	2776 RINGGOLD ROAD
Second Line	:	USA DENTAL ACTIVITY
City	:	FT. SILL
State	:	OK
Zip	:	73503
Country	:	US
Telephone Number	:	580-442-3905
Fax Number	:	580-442-4002

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	10/07/2010

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