Healthcare Provider Details

I. General information

NPI: 1407925050
Provider Name (Legal Business Name): STUART ROBB DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 1ST ST SUITE 440
HIGHLAND PARK IL
60035-3200
US

IV. Provider business mailing address

1435 N MCKINLEY RD
LAKE FOREST IL
60045-1327
US

V. Phone/Fax

Practice location:
  • Phone: 847-579-4777
  • Fax: 847-579-4785
Mailing address:
  • Phone: 847-295-5854
  • Fax: 847-295-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: