Provider Demographics
NPI:1053314732
Name:CODY, ROBERT CARROLL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARROLL
Last Name:CODY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 NORTHWEST BLVD
Mailing Address - Street 2:STE B3
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5114
Mailing Address - Country:US
Mailing Address - Phone:361-387-3559
Mailing Address - Fax:361-387-1286
Practice Address - Street 1:13701 NORTHWEST BLVD
Practice Address - Street 2:STE B3
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5114
Practice Address - Country:US
Practice Address - Phone:361-387-3559
Practice Address - Fax:361-387-1286
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice