Provider Demographics
NPI:1174721161
Name:ROBERTSON, JEFFREY C (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 IRVINE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1960
Mailing Address - Country:US
Mailing Address - Phone:714-838-7272
Mailing Address - Fax:714-838-0030
Practice Address - Street 1:4940 IRVINE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1960
Practice Address - Country:US
Practice Address - Phone:714-838-7272
Practice Address - Fax:714-838-0030
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist