MEDICARE: WILLIS MICHAEL 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	2061	NV

General Provider Information

NPI Number	:	1427065101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIS MICHAEL ROBINSON DDS

Provider Business Mailing Address
First Line	:	1111 NORTH DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1220
Country	:	US
Telephone Number	:	702-646-2030
Fax Number	:	702-646-2031

Provider Business Practice Location Address
First Line	:	1111 NORTH DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1220
Country	:	US
Telephone Number	:	702-646-2030
Fax Number	:	702-646-2031

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

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

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