Provider Demographics
NPI:1326153206
Name:BRENT M ROBINSON DDS PS
Entity Type:Organization
Organization Name:BRENT M ROBINSON DDS PS
Other - Org Name:ROBINSON DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-778-1164
Mailing Address - Street 1:19108 33RD AVE W
Mailing Address - Street 2:STE B
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4728
Mailing Address - Country:US
Mailing Address - Phone:425-778-1164
Mailing Address - Fax:425-771-7836
Practice Address - Street 1:19108 33RD AVE W
Practice Address - Street 2:STE B
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4728
Practice Address - Country:US
Practice Address - Phone:425-778-1164
Practice Address - Fax:425-771-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty