Provider Demographics
NPI:1992078265
Name:ROBERT L. LEPARD D.D.S.,P.A.
Entity type:Organization
Organization Name:ROBERT L. LEPARD D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-272-4957
Mailing Address - Street 1:121 W AVENUE B
Mailing Address - Street 2:
Mailing Address - City:MULESHOE
Mailing Address - State:TX
Mailing Address - Zip Code:79347-3611
Mailing Address - Country:US
Mailing Address - Phone:806-272-3446
Mailing Address - Fax:806-272-4921
Practice Address - Street 1:121 W AVENUE B
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3611
Practice Address - Country:US
Practice Address - Phone:806-272-3446
Practice Address - Fax:806-272-4921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0904062-02Medicaid
TXB14210-01OtherTEXAS CHIPS