Provider Demographics
NPI:1992053649
Name:ROBERSON, CASON J (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:CASON
Middle Name:J
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-4426
Mailing Address - Country:US
Mailing Address - Phone:931-455-0146
Mailing Address - Fax:931-393-3863
Practice Address - Street 1:205 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4426
Practice Address - Country:US
Practice Address - Phone:931-455-0146
Practice Address - Fax:931-393-3863
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist