MEDICARE: DR. BRENT M ROBINSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9394	WA

General Provider Information

NPI Number	:	1053426023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT M ROBINSON DDS

Provider Business Mailing Address
First Line	:	19108 33RD AVE W
Second Line	:	STE B
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-4728
Country	:	US
Telephone Number	:	206-778-1164
Fax Number	:	425-771-7836

Provider Business Practice Location Address
First Line	:	19108 33RD AVE W
Second Line	:	STE B
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-4728
Country	:	US
Telephone Number	:	206-778-1164
Fax Number	:	425-771-7836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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