Provider Demographics
NPI:1508375676
Name:ROBINSON, LACEY LEEANN (DDS)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:LEEANN
Last Name:ROBINSON
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:P.O. BOX 942
Mailing Address - Street 2:610 MILLER BOULEVARD
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532
Mailing Address - Country:US
Mailing Address - Phone:252-447-1135
Mailing Address - Fax:252-447-6956
Practice Address - Street 1:610 MILLER BOULEVARD
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532
Practice Address - Country:US
Practice Address - Phone:252-447-1135
Practice Address - Fax:252-447-6956
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice