Provider Demographics
NPI:1134123409
Name:DELL, ROBERT C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:DELL
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 1:19003 ECORSE RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2257
Mailing Address - Country:US
Mailing Address - Phone:313-382-3692
Mailing Address - Fax:313-928-0810
Practice Address - Street 1:19003 ECORSE RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2257
Practice Address - Country:US
Practice Address - Phone:313-382-3692
Practice Address - Fax:313-928-0810
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI121831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI626881OtherUNITED CONCORDIA
MI1958275510OtherBCBS
MIU68299Medicare UPIN
MIOM54330Medicare ID - Type Unspecified