Healthcare Provider Details

I. General information

NPI: 1427279264
Provider Name (Legal Business Name): ROBERT SHARPE DUSTIN JR. DMD, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 DEARFIELD DR
GREENWICH CT
06831-5349
US

IV. Provider business mailing address

68 DEARFIELD DR
GREENWICH CT
06831-5350
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-8711
  • Fax:
Mailing address:
  • Phone: 203-869-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7070
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: