MEDICARE: ROBINSON ORTHODONTICS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D008105	AZ

General Provider Information

NPI Number	:	1225416027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBINSON ORTHODONTICS

Provider Business Mailing Address
First Line	:	1635 N GREENFIELD RD
Second Line	:	SUITE 103
City	:	MESA
State	:	AZ
Zip	:	85205-4005
Country	:	US
Telephone Number	:	480-615-8888
Fax Number	:	480-615-8890

Provider Business Practice Location Address
First Line	:	1635 N GREENFIELD RD
Second Line	:	SUITE 103
City	:	MESA
State	:	AZ
Zip	:	85205-4005
Country	:	US
Telephone Number	:	480-615-8888
Fax Number	:	480-615-8890

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KRISTOFER KELLIS
Credential	:
Telephone Number	:	480-888-7711

Provider Enumeration Date	:	05/12/2015
Last Update Date	:	05/12/2015

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Directions to “ROBINSON ORTHODONTICS ” Practice Location

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