Provider Demographics
NPI:1205006707
Name:ROBINOS, MARY BOOTS FIESTA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY BOOTS
Middle Name:FIESTA
Last Name:ROBINOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5424 PORT SAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-2670
Mailing Address - Country:US
Mailing Address - Phone:510-364-9619
Mailing Address - Fax:
Practice Address - Street 1:2664 BERRYESSA RD
Practice Address - Street 2:SUITE 213
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2925
Practice Address - Country:US
Practice Address - Phone:510-364-9619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist