Provider Demographics
NPI:1992700785
Name:DOTY, ROBERT H (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:DOTY
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 1:4313 REGAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2978
Mailing Address - Country:US
Mailing Address - Phone:330-225-0105
Mailing Address - Fax:330-220-7883
Practice Address - Street 1:4313 REGAL AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-2978
Practice Address - Country:US
Practice Address - Phone:330-225-0105
Practice Address - Fax:330-220-7883
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
341343693OtherFEDERAL TAX ID
OH14831OtherSTATE LISCNESE NUMBER