MEDICARE: DR. ROSALIE REBECCA ROBBINS D.D.S.

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	DN10603	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN10603	OTHER	FL	DENTAL LICENSE NUMBER

General Provider Information

NPI Number	:	1164426052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSALIE REBECCA ROBBINS D.D.S.

Provider Business Mailing Address
First Line	:	2616 TAMIAMI TRL
Second Line	:	UNIT 8
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6473
Country	:	US
Telephone Number	:	941-743-3302
Fax Number	:	941-743-8448

Provider Business Practice Location Address
First Line	:	2616 TAMIAMI TRL
Second Line	:	UNIT 8
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6473
Country	:	US
Telephone Number	:	941-743-3302
Fax Number	:	941-743-8448

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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