Healthcare Provider Details

I. General information

NPI: 1598765604
Provider Name (Legal Business Name): ROBERT C. JOHN D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W BIG BEAVER RD STE 110
TROY MI
48084-3522
US

IV. Provider business mailing address

598 BARRINGTON PARK
BLOOMFIELD HILLS MI
48304-2122
US

V. Phone/Fax

Practice location:
  • Phone: 248-508-4641
  • Fax:
Mailing address:
  • Phone: 248-508-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2901017024
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901017024
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: