Provider Demographics
NPI:1851468128
Name:ROBERTSON, WADE WILLIAM (DDS)
Entity type:Individual
Prefix:MR
First Name:WADE
Middle Name:WILLIAM
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 1:5401 JFK BLVD
Mailing Address - Street 2:STE F
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116
Mailing Address - Country:US
Mailing Address - Phone:501-771-4500
Mailing Address - Fax:501-771-4502
Practice Address - Street 1:5401 JFK BLVD
Practice Address - Street 2:STE F
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116
Practice Address - Country:US
Practice Address - Phone:501-771-4500
Practice Address - Fax:501-771-4502
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR32201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice