Provider Demographics
NPI:1154769206
Name:STINSON, ROBERT WALTON (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WALTON
Last Name:STINSON
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 1:793 DUMPLIN VALLEY RD E
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4234
Mailing Address - Country:US
Mailing Address - Phone:865-712-2662
Mailing Address - Fax:
Practice Address - Street 1:331 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4621
Practice Address - Country:US
Practice Address - Phone:423-586-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist