Healthcare Provider Details

I. General information

NPI: 1720280258
Provider Name (Legal Business Name): CLYDE M. ROBINSON D.D.S.,M.SC.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
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:
Mailing address:
  • Phone: 520-327-0263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2163
License Number StateAZ

VIII. Authorized Official

Name: DR. CLYDE M. ROBINSON III
Title or Position: PRESIDENT
Credential: D.D.S.,M.SC.D.
Phone: 520-327-0263