Healthcare Provider Details

I. General information

NPI: 1376669937
Provider Name (Legal Business Name): ROBERT FREDERICK RIMSTIDT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 S WOODSCREST DR
BLOOMINGTON IN
47401-5524
US

IV. Provider business mailing address

515 S WOODSCREST DR
BLOOMINGTON IN
47401-5524
US

V. Phone/Fax

Practice location:
  • Phone: 812-336-4445
  • Fax: 812-336-6983
Mailing address:
  • Phone: 812-336-4445
  • Fax: 812-336-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6524
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: