Healthcare Provider Details

I. General information

NPI: 1336149236
Provider Name (Legal Business Name): ROBERT EDWARD SEXTON D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6695 E US HIGHWAY 36
AVON IN
46123-8923
US

IV. Provider business mailing address

6695 E US HIGHWAY 36
AVON IN
46123-8923
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-2200
  • Fax: 317-272-3714
Mailing address:
  • Phone: 317-272-2200
  • Fax: 317-272-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12006983
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: