Provider Demographics
NPI:1508924986
Name:ROBINSON, KENNETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
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 1:111 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2800
Mailing Address - Country:US
Mailing Address - Phone:315-339-2028
Mailing Address - Fax:315-339-2029
Practice Address - Street 1:111 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2800
Practice Address - Country:US
Practice Address - Phone:315-339-2028
Practice Address - Fax:315-339-2029
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0277141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery