Healthcare Provider Details

I. General information

NPI: 1558490029
Provider Name (Legal Business Name): ROSA H ROBISON MD DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 WESTOVER RESERVE BLVD
WINDERMERE FL
34786
US

IV. Provider business mailing address

5036 DR PHILLIPS BLVD # 315
ORLANDO FL
32819-3310
US

V. Phone/Fax

Practice location:
  • Phone: 407-286-2330
  • Fax: 407-523-0496
Mailing address:
  • Phone: 407-286-2330
  • Fax: 407-523-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSA H. ROBISON
Title or Position: MEDICAL DIRECTOR
Credential: M. D.
Phone: 407-286-2330