Provider Demographics
NPI:1083736821
Name:WALINCHUS, ROBERT E (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:WALINCHUS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-7414
Mailing Address - Country:US
Mailing Address - Phone:912-226-0019
Mailing Address - Fax:610-543-0299
Practice Address - Street 1:132 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-7414
Practice Address - Country:US
Practice Address - Phone:912-226-0019
Practice Address - Fax:912-356-1837
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN016031122300000X
PADS024091L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice