Healthcare Provider Details

I. General information

NPI: 1306986039
Provider Name (Legal Business Name): ROBERT B ROBINSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 DAVENPORT AVE.
MER ROUGE LA
71261
US

IV. Provider business mailing address

PO BOX 5
MER ROUGE LA
71261-0005
US

V. Phone/Fax

Practice location:
  • Phone: 318-647-5708
  • Fax:
Mailing address:
  • Phone: 318-647-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2867
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: