MEDICARE: ROBINSON DENTAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3464	LA

General Provider Information

NPI Number	:	1427476860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBINSON DENTAL GROUP

Provider Business Mailing Address
First Line	:	180 GLORIA DR STE 400
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70611-5043
Country	:	US
Telephone Number	:	337-429-5057
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 GLORIA DR STE 400
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70611-5043
Country	:	US
Telephone Number	:	337-429-5057
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY ROBINSON
Credential	:	D.D.S
Telephone Number	:	337-429-5057

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	04/02/2014

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