Provider Demographics
NPI:1346222874
Name:EDMONSTONE, ROBERT LADD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LADD
Last Name:EDMONSTONE
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 1:251 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-2357
Mailing Address - Country:US
Mailing Address - Phone:860-388-9855
Mailing Address - Fax:860-388-9855
Practice Address - Street 1:251 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2357
Practice Address - Country:US
Practice Address - Phone:860-388-0142
Practice Address - Fax:860-388-9855
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry