MEDICARE: DR. ROBIN SIMON BERRIN D.M.D.

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	1223G0001X	General Practice Dentistry	DD 2004	NM

General Provider Information

NPI Number	:	1104898840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN SIMON BERRIN D.M.D.

Provider Business Mailing Address
First Line	:	1117 CAESAR DR
Second Line	:
City	:	GALLUP
State	:	NM
Zip	:	87301-4974
Country	:	US
Telephone Number	:	505-863-6649
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 BONITA ST
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2103
Country	:	US
Telephone Number	:	505-876-4034
Fax Number	:

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	07/08/2007

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