Provider Demographics
NPI:1427476860
Name:ROBINSON DENTAL GROUP
Entity type:Organization
Organization Name:ROBINSON DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:337-429-5057
Mailing Address - Street 1:180 GLORIA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611-5043
Mailing Address - Country:US
Mailing Address - Phone:337-429-5057
Mailing Address - Fax:
Practice Address - Street 1:180 GLORIA DR STE 400
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611-5043
Practice Address - Country:US
Practice Address - Phone:337-429-5057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBINSON DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty