Provider Demographics
NPI:1043369689
Name:DEWAR, ROBERT T (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:DEWAR
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 1:1704 N ROBBERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-2845
Mailing Address - Country:US
Mailing Address - Phone:417-869-6055
Mailing Address - Fax:417-869-2469
Practice Address - Street 1:1704 N ROBBERSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-2845
Practice Address - Country:US
Practice Address - Phone:417-869-6055
Practice Address - Fax:417-869-2469
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11306Medicaid