MEDICARE: DR. ROGER LANCE 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	19-16406	IL

General Provider Information

NPI Number	:	1417952532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER LANCE ROBBINS D.D.S.

Provider Business Mailing Address
First Line	:	64 OLD ORCHARD CTR
Second Line	:	STE 528
City	:	SKOKIE
State	:	IL
Zip	:	60077-1440
Country	:	US
Telephone Number	:	847-675-3311
Fax Number	:	847-674-3133

Provider Business Practice Location Address
First Line	:	64 OLD ORCHARD CTR
Second Line	:	STE 528
City	:	SKOKIE
State	:	IL
Zip	:	60077-1440
Country	:	US
Telephone Number	:	847-675-3311
Fax Number	:	847-674-3133

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/08/2007

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