Healthcare Provider Details

I. General information

NPI: 1457960593
Provider Name (Legal Business Name): ELIZABETH S ROBINSON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 RENO DR
WAYLAND MI
49348-1732
US

IV. Provider business mailing address

899 RENO DR
WAYLAND MI
49348-1732
US

V. Phone/Fax

Practice location:
  • Phone: 269-792-9557
  • Fax:
Mailing address:
  • Phone: 269-792-9557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ROBINSON
Title or Position: OWNER
Credential: DDS
Phone: 616-550-9721