Provider Demographics
NPI:1497972061
Name:ROBINSON, REESE JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:REESE
Middle Name:JOHN
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MASON ST
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-1536
Mailing Address - Country:US
Mailing Address - Phone:251-867-3273
Mailing Address - Fax:251-867-3274
Practice Address - Street 1:102 MASON ST
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426
Practice Address - Country:US
Practice Address - Phone:251-867-3273
Practice Address - Fax:251-867-3274
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630821835OtherTAX IDENTIFICATION NUMBER