Provider Demographics
NPI:1164711982
Name:DICKMAN, ROBIN ELLEN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:ELLEN
Last Name:DICKMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NYE ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-2113
Mailing Address - Country:US
Mailing Address - Phone:715-531-0534
Mailing Address - Fax:
Practice Address - Street 1:510 NYE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-2113
Practice Address - Country:US
Practice Address - Phone:715-531-0534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9946-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist