Randy M Robertson, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

13503 Issued in TX

Practice address

1309 N Ave C
Elgin, TX 78621

Phone

(512) 281-4260

Fax

(512) 285-3229

NPI assigned

Sep 7, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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 TX

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

State licenses

Practice roles

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

• Tippit Dental Group Elgin

  dba Elgin Smiles Dental

  • Dental Clinic/Center
  • Elgin, TX
  • NPI 1255006532
  NPD (past)

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467555086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 897",
            "city": "ELGIN",
            "state": "TX",
            "postal_code": "78621",
            "telephone_number": "512-281-4260",
            "fax_number": "512-285-3229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1309 N AVE C",
            "city": "ELGIN",
            "state": "TX",
            "postal_code": "78621",
            "telephone_number": "512-281-4260",
            "fax_number": "512-285-3229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "RANDY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "13503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Tatman Potts, PT
• Shelbylynn Prieto, LPC-A
• Julie Ann Restall, DC
• Monica Gayle Reyna, LPC
• Mary Doan Le Reynera, PA-C
• Brent Allen Roper, R.PH.
• Bridget Roper, R.PH.
• Allison Rosen, OTR
• Mario Angel Ruiz
• Clayton William Rutkowski, OD

• Dentist in Elgin, TX
• Providers in Elgin, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.