Active NPI
Paul Lamont Robertson, DDS
- Dentist
- Fort Dodge, IA
National Provider Identifier
1083849715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 01783
- Practice address
- 126 N 10TH St
Fort Dodge, IA 50501-3915 - Phone
- (515) 576-6500
- Fax
- (515) 576-1951
- NPI assigned
- May 26, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 01783 | IA | Primary |
Addresses
Primary practice location
126 N 10TH St
Fort Dodge, IA 50501-3915
Mailing address
126 N 10TH St
Fort Dodge, IA 50501-3915
Phone (515) 576-6500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01783 | IA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246838400000",
"number": "1083849715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "126 N 10TH ST",
"city": "FORT DODGE",
"state": "IA",
"postal_code": "505013915",
"telephone_number": "515-576-6500",
"fax_number": "515-576-1951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "126 N 10TH ST",
"city": "FORT DODGE",
"state": "IA",
"postal_code": "505013915",
"telephone_number": "515-576-6500",
"fax_number": "515-576-1951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "PAUL",
"middle_name": "LAMONT",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-05-26",
"last_updated": "2009-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IA",
"license": "01783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Dodge, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.