Provider Demographics
NPI:1992588438
Name:ROBLES, ALBERT (DMD, MSOB)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:ROBLES
Suffix:
Gender:M
Credentials:DMD, MSOB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HARROLD ST APT 624
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2896
Mailing Address - Country:US
Mailing Address - Phone:347-962-4974
Mailing Address - Fax:
Practice Address - Street 1:1561 SW WILSHIRE BLVD STE 435
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8724
Practice Address - Country:US
Practice Address - Phone:817-409-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034581122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics