Provider Demographics
NPI:1124046685
Name:ROBITAILLE, PHILIP MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MICHAEL
Last Name:ROBITAILLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 SLADES FERRY AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:MA
Mailing Address - Zip Code:02726-1201
Mailing Address - Country:US
Mailing Address - Phone:508-674-0551
Mailing Address - Fax:239-236-2100
Practice Address - Street 1:191 SLADES FERRY AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:MA
Practice Address - Zip Code:02726-1201
Practice Address - Country:US
Practice Address - Phone:508-674-0551
Practice Address - Fax:239-236-2100
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist