Provider Demographics
NPI:1306862099
Name:JOSE, ROBERT JOHN (DMD, FAGD, PC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:JOSE
Suffix:
Gender:M
Credentials:DMD, FAGD, PC
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:JOHN
Other - Last Name:JOSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, FAGD, PC
Mailing Address - Street 1:1010 PARTRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0516
Mailing Address - Country:US
Mailing Address - Phone:406-449-7813
Mailing Address - Fax:406-495-6092
Practice Address - Street 1:1010 PARTRIDGE PL
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0516
Practice Address - Country:US
Practice Address - Phone:406-449-7813
Practice Address - Fax:406-495-6092
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0112999Medicaid