Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 11450 | TX |
NPI | 1003864653 |
---|---|
Provider Name | Dr. Tom Marvin Robertson |
First Address | Houston, TX 77024-4047 |
Second Address | Houston, TX 77024-4047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 30/03/2017 |