Healthcare Provider Details

I. General information

NPI: 1932118064
Provider Name (Legal Business Name): ROBERT E CLINE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BOB E CLINE

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 KOHLER MEMORIAL DR
SHEBOYGAN WI
53081
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 920-457-4461
  • Fax: 920-459-1404
Mailing address:
  • Phone: 414-647-6326
  • Fax: 414-671-8860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number5001424-015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: