Provider Demographics
NPI:1225416027
Name:ROBINSON ORTHODONTICS
Entity Type:Organization
Organization Name:ROBINSON ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-888-7711
Mailing Address - Street 1:1635 N GREENFIELD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4005
Mailing Address - Country:US
Mailing Address - Phone:480-615-8888
Mailing Address - Fax:480-615-8890
Practice Address - Street 1:1635 N GREENFIELD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4005
Practice Address - Country:US
Practice Address - Phone:480-615-8888
Practice Address - Fax:480-615-8890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBISON ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0081051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty