Healthcare Provider Details

I. General information

NPI: 1659339729
Provider Name (Legal Business Name): ROBERT H ROBINSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 GRAYSON HWY
LAWRENCEVILLE GA
30046-7171
US

IV. Provider business mailing address

PO BOX 897
LAWRENCEVILLE GA
30046-0897
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-5642
  • Fax: 770-963-6138
Mailing address:
  • Phone: 770-339-4260
  • Fax: 770-963-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN009375
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: