Provider Demographics
NPI:1174960223
Name:ROBERTSON, KAREN LOUISE (RDH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LOUISE
Other - Last Name:KALISEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:15 MOHEGAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-8100
Mailing Address - Country:US
Mailing Address - Phone:860-444-8424
Mailing Address - Fax:
Practice Address - Street 1:15 MOHEGAN AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-8100
Practice Address - Country:US
Practice Address - Phone:860-444-8424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007205124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist