Organization
MATTHEW E ROBERTSON DMD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW E ROBERTSON DMD (OWNER)
(316) 722-0800
Entity
Organization
Contact information
Practice address
3510 N RIDGE RD, STE 500, WICHITA, KS 67205-1224
(316) 722-0800
(316) 722-5822
Mailing address
3510 N RIDGE RD, STE 500, WICHITA, KS 67205-1224
(316) 722-0800
(316) 722-5822
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
60512
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200557210A
—
KS
Enumeration date
05/07/2012
Last updated
06/20/2012
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