Provider Demographics
NPI:1043422199
Name:ROBERT L. DAGUE D.D.S
Entity Type:Organization
Organization Name:ROBERT L. DAGUE D.D.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:DAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-222-0939
Mailing Address - Street 1:2081 VICTOR AVE.
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0410
Mailing Address - Country:US
Mailing Address - Phone:530-222-0939
Mailing Address - Fax:530-222-6017
Practice Address - Street 1:2081 VICTOR AVE.
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0410
Practice Address - Country:US
Practice Address - Phone:530-222-0939
Practice Address - Fax:530-222-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA239991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty