Provider Demographics
NPI:1285840629
Name:SZABO, ROBERT J (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:SZABO
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 1:2424 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-3422
Mailing Address - Country:US
Mailing Address - Phone:574-259-1464
Mailing Address - Fax:574-259-2182
Practice Address - Street 1:2424 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-3422
Practice Address - Country:US
Practice Address - Phone:574-259-1464
Practice Address - Fax:574-259-2182
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120089401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice