Provider Demographics
NPI:1104019793
Name:KISER, ROBINSON TODD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBINSON
Middle Name:TODD
Last Name:KISER
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 1:121 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-2822
Mailing Address - Country:US
Mailing Address - Phone:913-250-6583
Mailing Address - Fax:
Practice Address - Street 1:121 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-2822
Practice Address - Country:US
Practice Address - Phone:913-250-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6620034-9921122300000X
KS609531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist