Provider Demographics
NPI:1275547630
Name:TUBB, ROBERT MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:TUBB
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 1:1220 N TOWNEAST BLVD
Mailing Address - Street 2:SUITE #338
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-682-0200
Mailing Address - Fax:972-682-0866
Practice Address - Street 1:1220 N TOWNEAST BLVD
Practice Address - Street 2:SUITE #338
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-682-0200
Practice Address - Fax:972-682-0866
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16465122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist