Healthcare Provider Details

I. General information

NPI: 1508924986
Provider Name (Legal Business Name): KENNETH ROBINSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E CHESTNUT ST
ROME NY
13440-2800
US

IV. Provider business mailing address

111 E CHESTNUT ST
ROME NY
13440-2800
US

V. Phone/Fax

Practice location:
  • Phone: 315-339-2028
  • Fax: 315-339-2029
Mailing address:
  • Phone: 315-339-2028
  • Fax: 315-339-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number027714
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: