Healthcare Provider Details

I. General information

NPI: 1427476860
Provider Name (Legal Business Name): ROBINSON DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 GLORIA DR STE 400
LAKE CHARLES LA
70611-5043
US

IV. Provider business mailing address

180 GLORIA DR STE 400
LAKE CHARLES LA
70611-5043
US

V. Phone/Fax

Practice location:
  • Phone: 337-429-5057
  • Fax:
Mailing address:
  • Phone: 337-429-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3464
License Number StateLA

VIII. Authorized Official

Name: TIMOTHY ROBINSON
Title or Position: OWNER
Credential: D.D.S
Phone: 337-429-5057