MEDICARE: DR. ALICIA ROBERTSON,PA 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	9636	MD

General Provider Information

NPI Number	:	1760632533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA ROBERTSON,PA D.D.S

Provider Business Mailing Address
First Line	:	9417 FLOWER AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-3402
Country	:	US
Telephone Number	:	301-588-3310
Fax Number	:

Provider Business Practice Location Address
First Line	:	9417 FLOWER AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-3402
Country	:	US
Telephone Number	:	301-588-3310
Fax Number	:	301-588-3595

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

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	12/11/2017

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