Provider Demographics
NPI:1164091302
Name:ESTES, ROBERT E (DENTURIST)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:ESTES
Suffix:
Gender:M
Credentials:DENTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-3369
Mailing Address - Country:US
Mailing Address - Phone:509-201-1051
Mailing Address - Fax:
Practice Address - Street 1:315 N SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3369
Practice Address - Country:US
Practice Address - Phone:509-201-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604719821122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist