Provider Demographics
NPI:1124138441
Name:MUMFORD, ROBERT STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STEPHEN
Last Name:MUMFORD
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 1:270 FARMINGTON AVE
Mailing Address - Street 2:STE 233
Mailing Address - City:FARMINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-677-5655
Mailing Address - Fax:
Practice Address - Street 1:270 FARMINGTON AVE
Practice Address - Street 2:STE 233
Practice Address - City:FARMINGTON
Practice Address - State:CO
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-677-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist