Individual
DR. MATTHEW ERIC ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
12611 E 21ST ST N, WICHITA, KS 67206-3594
(316) 742-1506
Mailing address
12611 E 21ST ST N, WICHITA, KS 67206-3594
(316) 742-1506
(316) 742-1507
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
21514
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
60512
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345
NONE
—
Enumeration date
04/04/2006
Last updated
05/15/2024
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