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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871607812 NPPES
Mississippi MEDICAID 00660451
Mississippi MEDICAID 01951327

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