Individual
DR. JARED ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
10000 COORS BYP NW, SUITE G218, ALBUQUERQUE, NM 87114-4040
(505) 242-4867
(505) 890-2883
Mailing address
10000 COORS BYP NW, SUITE G218, ALBUQUERQUE, NM 87114-4040
(505) 242-4867
(505) 890-2883
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD3699
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD3699
STATE DENTAL LISENCE
NM
Enumeration date
07/12/2012
Last updated
07/12/2012
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