Healthcare Provider Details

I. General information

NPI: 1568418796
Provider Name (Legal Business Name): MICHAEL C. ROBINSON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 4TH ST
LEAVENWORTH KS
66048-5015
US

IV. Provider business mailing address

3601 S 4TH ST
LEAVENWORTH KS
66048-5015
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-5926
  • Fax: 913-682-4082
Mailing address:
  • Phone: 913-682-5926
  • Fax: 913-682-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5296
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: