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NPI Code Detail

MEDICARE: DR. ROBERTSON DAVID LOAR

MEDICARE: DR. ROBERTSON DAVID LOAR
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
1122300000XDentist1947SC

General Provider Information

NPI Number : 1962481358
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERTSON DAVID LOAR
Provider Business Mailing Address
First Line : 3259 CATLIN AVE
Second Line :
City : QUANTICO
State : VA
Zip : 22134-5109
Country : US
Telephone Number : 703-784-1853
Fax Number :
Provider Business Practice Location Address
First Line : 3259 CATLIN AVE
Second Line :
City : QUANTICO
State : VA
Zip : 22134-5109
Country : US
Telephone Number : 703-784-1853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 07/08/2007

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Directions to “ DR. ROBERTSON DAVID LOAR ” Practice Location

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