Individual
MRS. MISTY DAWN ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
3700 N PERIMETER ROAD, MALMSTROM AFB, MT 59402
(406) 731-2846
Mailing address
PO BOX 1025, GREAT FALLS, MT 59403-1025
(406) 781-4746
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
1125
MT
124Q00000X
Dental Hygienist
2004015668
MO
124Q00000X
Dental Hygienist
760
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1125
DENTAL HYGIENE LICENSE
MT
01
—
2004015668
DENTAL HYGIENE LICEENSE
MO
01
—
760
DENTAL HYGIENE LICENSE
WY
Enumeration date
01/26/2007
Last updated
07/08/2007
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