Healthcare Provider Details

I. General information

NPI: 1316992738
Provider Name (Legal Business Name): ROBERT JAMES HOUCHIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 US HIGHWAY 395 N STE 10335
GARDNERVILLE NV
89410
US

IV. Provider business mailing address

1329 US HIGHWAY 395 NORTH SUITE 10 BOX 335
GARDNERVILLE NV
89410
US

V. Phone/Fax

Practice location:
  • Phone: 909-576-3999
  • Fax:
Mailing address:
  • Phone: 909-576-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD008977
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28166
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4525
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: