Roberson, John Boone
Roberson, John Boone is an individual health care provider with primary practice located at 811 South 28Th Avenue , Hattiesburg MS 39402. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Roberson, John Boone can be contacted via phone (601) 261-2611.Contact Information
Primary practice address
811 South 28Th Avenue
Hattiesburg MS 39402
Phone: (601) 261-2611
Fax: (601) 261-2711
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | 274693 | Mississippi |
Profile Details
| NPI number | 1871607812 |
|---|---|
| LBN Legal business name | Roberson, John Boone |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 18th, 2006 |
| Last updated | Mar 7th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871607812 | NPPES |
| Mississippi | MEDICAID | 00660451 | |
| Mississippi | MEDICAID | 01951327 |
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