Provider Demographics
NPI:1104921253
Name:ROBERSON, JAMES MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 STAGE RD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3731
Mailing Address - Country:US
Mailing Address - Phone:901-388-6191
Mailing Address - Fax:901-937-5091
Practice Address - Street 1:6425 STAGE RD
Practice Address - Street 2:SUITE #6
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3731
Practice Address - Country:US
Practice Address - Phone:901-388-6191
Practice Address - Fax:901-937-5091
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS45761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice