Healthcare Provider Details

I. General information

NPI: 1114361045
Provider Name (Legal Business Name): AMANDA RENEE ROBINSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 9TH ST
IMPERIAL BEACH CA
91932-1508
US

IV. Provider business mailing address

629 9TH ST
IMPERIAL BEACH CA
91932-1508
US

V. Phone/Fax

Practice location:
  • Phone: 619-424-5115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number51373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: