Provider Demographics
NPI:1427260892
Name:CARL, ROBERT ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:CARL
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 1:708 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4205
Mailing Address - Country:US
Mailing Address - Phone:505-327-6155
Mailing Address - Fax:505-327-6156
Practice Address - Street 1:708 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4205
Practice Address - Country:US
Practice Address - Phone:505-327-6155
Practice Address - Fax:505-327-6156
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD 15691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice