Provider Demographics
NPI:1154546307
Name:ROBERTSON, BRIAN HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HOWARD
Last Name:ROBERTSON
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 1:12 TRINE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17065-1143
Mailing Address - Country:US
Mailing Address - Phone:717-486-5704
Mailing Address - Fax:
Practice Address - Street 1:34 N BALTIMORE AVE
Practice Address - Street 2:APT. 1
Practice Address - City:MOUNT HOLLY SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17065-1328
Practice Address - Country:US
Practice Address - Phone:717-486-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-021815-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice