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General NPI Number Information
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NPI Number | 1790130177
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Entity Type | Organization
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Legal Business Name | LAKEWAY DENTAL OFFICE, P.A.
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 2220 LAKEWAY BLVD. SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78734-5132
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Country | US
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Telephone | 512-261-5522
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Fax | 512-261-7084
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Provider Business Mailing Address
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Address Line | 2220 LAKEWAY BLVD. SUITE 200
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City | AUSTIN
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State | TX
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Zip | 78734-5132
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Country | US
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Telephone | 512-261-5522
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Fax | 512-261-7084
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT VICTOR ROBINSON
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Credential | DDS
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Telephone | 512-261-5522
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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 | 15663
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License Number State | TX
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