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General NPI Number Information
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NPI Number | 1720430408
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Entity Type | Individual
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Provider Name | STACEY ROBBEN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 128 MARKET ST
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City | ALAMOSA
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State | CO
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Zip | 81101-2290
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Country | US
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Telephone | 719-589-9691
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Fax |
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Provider Business Mailing Address
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Address Line | 707 LEE DR
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City | ALAMOSA
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State | CO
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Zip | 81101-2038
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Country | US
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Telephone | 720-308-1464
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00202888
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License Number State | CO
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