Provider Demographics
NPI:1275619231
Name:WINDOM, ROBERT WILSON III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILSON
Last Name:WINDOM
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 SUMNER PL
Mailing Address - Street 2:
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-1324
Mailing Address - Country:US
Mailing Address - Phone:913-684-5004
Mailing Address - Fax:913-684-6609
Practice Address - Street 1:600 CAISSON HILL ROAD
Practice Address - Street 2:
Practice Address - City:FT. RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-5043
Practice Address - Country:US
Practice Address - Phone:785-239-7241
Practice Address - Fax:785-239-7245
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS1999-821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice