Provider Demographics
NPI:1437143294
Name:ROBISON, MARY LETHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LETHA
Last Name:ROBISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 TEMPLETON GAP RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5735
Mailing Address - Country:US
Mailing Address - Phone:719-630-7727
Mailing Address - Fax:719-630-7739
Practice Address - Street 1:3235 TEMPLETON GAP RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5735
Practice Address - Country:US
Practice Address - Phone:719-630-7727
Practice Address - Fax:719-630-7739
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1057321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice