Provider Demographics
NPI:1164643029
Name:ROBINSON, GUY ELLIOT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:ELLIOT
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 1:149 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-2423
Mailing Address - Country:US
Mailing Address - Phone:908-352-4314
Mailing Address - Fax:908-352-3530
Practice Address - Street 1:149 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2423
Practice Address - Country:US
Practice Address - Phone:908-352-4314
Practice Address - Fax:908-352-3530
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO14502001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2012308-01Medicaid