Provider Demographics
NPI:1124294954
Name:ROBIN, BETTE
Entity type:Individual
Prefix:DR
First Name:BETTE
Middle Name:
Last Name:ROBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17482 IRVINE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3032
Mailing Address - Country:US
Mailing Address - Phone:714-421-4409
Mailing Address - Fax:714-398-8808
Practice Address - Street 1:17482 IRVINE BLVD STE A
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3032
Practice Address - Country:US
Practice Address - Phone:714-421-4409
Practice Address - Fax:714-398-8808
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31972OtherPPO