Healthcare Provider Details

I. General information

NPI: 1083728703
Provider Name (Legal Business Name): ROBERT G DINMORE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 SOUND BEACH AVE
OLD GREENWICH CT
06870-1607
US

IV. Provider business mailing address

279 SOUND BEACH AVE
OLD GREENWICH CT
06870-1607
US

V. Phone/Fax

Practice location:
  • Phone: 203-637-3102
  • Fax: 203-637-5750
Mailing address:
  • Phone: 203-637-3102
  • Fax: 203-637-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number004610
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: