Provider Demographics
NPI:1073957734
Name:ROBINSON, BRAND D (DDS)
Entity Type:Individual
Prefix:
First Name:BRAND
Middle Name:D
Last Name:ROBINSON
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 1:4265 FALLON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6797
Mailing Address - Country:US
Mailing Address - Phone:406-587-7411
Mailing Address - Fax:406-587-2357
Practice Address - Street 1:4265 FALLON ST STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6797
Practice Address - Country:US
Practice Address - Phone:406-587-7411
Practice Address - Fax:406-587-2357
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT130052Medicaid