Provider Demographics
NPI:1073521050
Name:ISRAEL, ROBERT S (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:ISRAEL
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 1:1230 SATELLITE BLVD NW
Mailing Address - Street 2:ST 100
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3212
Mailing Address - Country:US
Mailing Address - Phone:770-476-9192
Mailing Address - Fax:770-476-9193
Practice Address - Street 1:1230 SATELLITE BLVD NW
Practice Address - Street 2:ST 100
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3212
Practice Address - Country:US
Practice Address - Phone:770-476-9192
Practice Address - Fax:770-476-9193
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist