Provider Demographics
NPI:1588762579
Name:HISLOP, ROBERT SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:HISLOP
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 1:9055A GAITHER ROAD
Mailing Address - Street 2:SHADY GROVE CENTER
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1461
Mailing Address - Country:US
Mailing Address - Phone:301-840-0070
Mailing Address - Fax:301-963-4737
Practice Address - Street 1:9055A GAITHER ROAD
Practice Address - Street 2:SHADY GROVE CENTER
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1461
Practice Address - Country:US
Practice Address - Phone:301-840-0070
Practice Address - Fax:301-963-4737
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist