Mark Alan Robertson, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

9993 Issued in TN

Practice address

105 Hudson Dr
Elizabethton, TN 37643-2801

Phone

(423) 543-5263

Fax

(423) 543-5006

NPI assigned

Sep 27, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Robertson Dental PLLC

  • General Practice Dentistry
  • Elizabethton, TN
  • NPI 1003205535

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1235448150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 HUDSON DR",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432801",
            "telephone_number": "423-543-5263",
            "fax_number": "423-543-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 HUDSON DR",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432801",
            "telephone_number": "423-543-5263",
            "fax_number": "423-543-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "MARK",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-27",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TN",
            "license": "9993",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Woodward
• Riverside Pedatrics PLLC
• Robert L Sams
• Kristie Dawn Roberts
• Robertson Dental PLLC
• Diane Lynn Roche, PA
• Kaylee Rose, M.S., CF-SLP
• Larry James Rose, L.C.S.W.
• Faith Russell, PT, DPT
• Christine Marie Sager, M.D.

• Dentist in Elizabethton, TN
• Providers in Elizabethton, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.