Provider Demographics
NPI:1407922651
Name:HAMBLIN, ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HAMBLIN
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 1:4196 N 430 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5159
Mailing Address - Country:US
Mailing Address - Phone:801-225-4470
Mailing Address - Fax:801-371-0211
Practice Address - Street 1:1260 S HOVER ST
Practice Address - Street 2:UNIT H
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7911
Practice Address - Country:US
Practice Address - Phone:303-678-1125
Practice Address - Fax:303-678-8986
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO82621223G0001X
UT1416491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice