Healthcare Provider Details

I. General information

NPI: 1306204037
Provider Name (Legal Business Name): MAURA ROBINSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 N OUTER 40 RD STE 360
TOWN AND COUNTRY MO
63017-5941
US

IV. Provider business mailing address

13001 N OUTER 40 RD STE 360
TOWN AND COUNTRY MO
63017-5941
US

V. Phone/Fax

Practice location:
  • Phone: 314-626-4579
  • Fax: 314-485-4820
Mailing address:
  • Phone: 314-626-4579
  • Fax: 314-485-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2016023890
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2016023890
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: