Healthcare Provider Details

I. General information

NPI: 1518027093
Provider Name (Legal Business Name): ROBERT K FLATH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 HILLTOP DR SUITE 209
ROCK SPRINGS WY
82901
US

IV. Provider business mailing address

1208 HILLTOP DR SUITE 209
ROCK SPRINGS WY
82901
US

V. Phone/Fax

Practice location:
  • Phone: 307-362-4867
  • Fax:
Mailing address:
  • Phone: 307-362-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3115839921
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1022
License Number StateWY
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3115839921
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1022
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: