Provider Demographics
NPI:1346427820
Name:MENSAH, ROBERT K (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:MENSAH
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 1:1401 MERCANTILE LN STE 102
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4306
Mailing Address - Country:US
Mailing Address - Phone:301-773-7703
Mailing Address - Fax:301-773-7708
Practice Address - Street 1:1401 MERCANTILE LN STE 102
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:301-773-7703
Practice Address - Fax:301-773-7708
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-27
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD160171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC091770900Medicaid
MD097190100Medicaid