Provider Demographics
NPI:1679677728
Name:BINGHAM, ROBIN T (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:T
Last Name:BINGHAM
Suffix:
Gender:F
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:NAS WHITING FIELD
Mailing Address - Street 2:7119 LANGLEY ST
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570
Mailing Address - Country:US
Mailing Address - Phone:850-623-7657
Mailing Address - Fax:
Practice Address - Street 1:7119 LANGLEY ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-6105
Practice Address - Country:US
Practice Address - Phone:850-623-7657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012517122300000X
GADN0125171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000947042FMedicaid