Provider Demographics
NPI:1013028851
Name:AXELROD, ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:AXELROD
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 1:105 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6348
Mailing Address - Country:US
Mailing Address - Phone:203-261-8749
Mailing Address - Fax:203-261-2219
Practice Address - Street 1:105 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6348
Practice Address - Country:US
Practice Address - Phone:203-261-8749
Practice Address - Fax:203-261-2219
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0060181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice