Healthcare Provider Details

I. General information

NPI: 1144271974
Provider Name (Legal Business Name): CLYDE M ROBINSON D.D.S.,M.SC.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 N ROSEMONT BLVD #A
TUCSON AZ
85712-2163
US

IV. Provider business mailing address

2330 N ROSEMONT BLVD #A
TUCSON AZ
85712-2163
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-0263
  • Fax: 520-327-0965
Mailing address:
  • Phone: 520-327-0263
  • Fax: 520-327-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberA2163
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: