Healthcare Provider Details

I. General information

NPI: 1548301237
Provider Name (Legal Business Name): ROBERT B ROBINSON APDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/21/2018
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: 318-647-9949
Mailing address:
  • Phone: 318-647-5708
  • Fax: 318-647-9949

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: ROBERT B ROBINSON
Title or Position: PRESIDENT
Credential: DDS
Phone: 318-647-5708