Provider Demographics
NPI:1407926801
Name:MAROON, ROBERT EDWARD (DDS,FICOI)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:MAROON
Suffix:
Gender:M
Credentials:DDS,FICOI
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:EDWARD
Other - Last Name:MAROON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS,FICOI
Mailing Address - Street 1:374 E H ST
Mailing Address - Street 2:SUITE 1710
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7484
Mailing Address - Country:US
Mailing Address - Phone:619-691-0400
Mailing Address - Fax:619-691-7783
Practice Address - Street 1:374 E H ST
Practice Address - Street 2:SUITE 1710
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7484
Practice Address - Country:US
Practice Address - Phone:619-691-0400
Practice Address - Fax:619-691-7783
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice