Provider Demographics
NPI:1902061807
Name:ALBISTON, ROBERT STANLEY (DDS)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STANLEY
Last Name:ALBISTON
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 1:1513 ROCKWOOD
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3922
Mailing Address - Country:US
Mailing Address - Phone:435-225-1656
Mailing Address - Fax:
Practice Address - Street 1:610 CUBA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5922
Practice Address - Country:US
Practice Address - Phone:575-434-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4568122300000X
UT7330714-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist